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Anson Cheung, MD, John G. Webb, MD, Daniel R

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1 Transapical Transcatheter Mitral Valve-in-Valve Implantation in a Human 
Anson Cheung, MD, John G. Webb, MD, Daniel R. Wong, MD, MPH, Jian Ye, MD, Jean-Bernard Masson, MD, Ronald G. Carere, MD, Samuel V. Lichtenstein, MD, PhD  The Annals of Thoracic Surgery  Volume 87, Issue 3, Pages e18-e20 (March 2009) DOI: /j.athoracsur Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 (Left) Technique for transapical mitral valve-in-valve implantation shows the cuffed valve being deployed within the bioprosthesis (cut away). (Panel a) Pigtail catheter in the apex during preoperative angiography. The xenograft commissural posts are marked by the radiopaque nickel-cobalt alloy wire form, with the support ring also visible. Intraoperative fluoroscopy demonstrates (b) balloon valvuloplasty, (c) positioning the transcatheter valve (a few millimeters atrially beyond the support ring), and (d) deployment. The Annals of Thoracic Surgery  , e18-e20DOI: ( /j.athoracsur ) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 The fabric cuff surrounding the Cribier-Edwards transcatheter valve may provide a better seal for valve-in-valve applications (photograph courtesy of Edwards Lifesciences LLC, Irvine, CA). The Annals of Thoracic Surgery  , e18-e20DOI: ( /j.athoracsur ) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 The transcatheter mitral valve-in-valve viewed by cineangiography 5 weeks postoperatively shows (a) lateral view and (b) coaxial view. The Annals of Thoracic Surgery  , e18-e20DOI: ( /j.athoracsur ) Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

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