Transcatheter Mitral Valve-in-Valve Implantation in a 13-Year-Old Female
with a Degenerated Bioprosthetic Mitral Valve: Case Report
Abstract
Background: On June 05, 2017, the U.S. Food and Drug Administration
approved the Edwards Lifesciences SAPIEN S3 Valve for transcatheter
mitral valve replacement of degenerated bioprosthetic mitral valves. We
present a case of the youngest patient (13 years old) to undergo this
procedure. Case presentation: At 10 years old, this female patient
underwent bioprosthetic mitral valve replacement. Three years later, she
began experiencing shortness of breath NYHA class III. A transthoracic
echocardiography showed a degenerated bioprosthetic mitral valve and
severe mitral stenosis with a mean pressure gradient of 18 mm Hg. After
deeming the patient, a high risk for surgery, the heart team opted to
perform a transcatheter mitral valve-in-valve replacement. After the
valve delivery system crossed the degenerated valve, a SAPIEN valve
balloon was slowly inflated without rapid pacing to allow for fine
positioning. Transoesophageal echocardiography evaluation revealed a
mean gradient of 5 mm Hg. The patient discharged after 2 days. At her
30-month follow-up, she reported regular daily activity with no
shortness of breath, and a follow-up transthoracic echocardiography
showed normal function of the right ventricle, which also had reduced in
size. Her systolic pulmonary artery pressure decreased to 33 mm Hg, the
mean pressure gradient of the left ventricular outflow tract was 10 mm
Hg, and the mitral valve mean pressure gradient was 6 mm Hg. Case
discussion: Transcatheter mitral valve replacement is feasible in young
female patients with a small body surface area. Safety and long-term
outcomes need more research in this age group.