Transcatheter Mitral Valve-in-Valve Replacement Guided by 3-Dimensional Printing to Treat Patient Who Successively Underwent Mitral Valve Replacement, Tricuspid Valvuloplasty, and Transcatheter Aortic Valve Replacement

Abstract

Objective: We describe a case of Transcatheter Mitral Valve-In-Valve Replacement (TMViVR) successfully performed under the guidance of 3-Dimensional (3D) printing. Case presentation:A 76-year-old man presented with palpitations, shortness of breath, and chest tightness 2 months ago, and the symptoms continued to worsen. Transthoracic echocardiography showed mitral stenosis with bioprosthetic degeneration and New York Heart Association functional class III. The patient underwent mitral valve replacement 11 years ago for mitral stenosis, and he underwent tricuspid valvuloplasty 6 years ago because of tricuspid regurgitation after mitral valve replacement. One year ago, the patient developed clinical symptoms again. Transthoracic echocardiography showed aortic regurgitation combined with stenosis (PG max =25 mmHg), and transcatheter aortic valve replacement was performed. In combination with his multiple operations, we used 3D printing for preoperative assessment and digital subtraction angiography for intraoperative guidance to complete the TMViVR. After the procedures, digital subtraction angiography showed that the bioprosthesis was in a good position and opened and closed normally. Furthermore, transesophageal echocardiography showed that the morphology and motion of the leaflets were good, the blood flow rate was normal, and there was no paravalvular leak. The 3D-printed model prepared after TMViVR showed the good position of the bioprosthesis and normal morphology. Conclusion:Preoperative assessment and 3D printing guidance may play an auxiliary role when treating patients with high surgical risk undergoing TMViVR.