case_images: PMC10927942_01
case_images: (A-C) intraoperative transoesophageal echocardiography confirmed severe aortic and MR. (D) Transapical TAVR was performed under fluoroscopic guidance using a 29 mm J-Valve (JieCheng Medical) as previously described, and aortic root angiography revealed minimal regurgitation. (E,F) After TAVR, the grade of MR remained severe.
case_images: fcvm-11-1346022-g001.jpg
case_images: PMC10927942_01_fcvm-11-1346022-g001.jpg
case_images: F1
case_images: On current evaluation, Transthoracic echocardiography revealed severe aortic and MR, with a left ventricular ejection fraction of 37% and a left ventricular end-diastolic diameter of 64 mm (Figures 1A-C). Aortic root angiography revealed minimal regurgitation around the aortic valve, and the delivery sheath was carefully removed under fluoroscopy (Figure 1D, Figure 2E). TAVR surgery, the level of MR remained severe (Figures 1E,F). A 16F sheath was then inserted through the original puncture site, and wire manipulation confirmed proper alignment towards the mitral valve.
case_images: (A,B) under transoesophageal echocardiography guidance, one clip was implanted between the A2 and P2 leaflets. Transoesophageal echocardiography with 3D reconstruction demonstrated appropriate morphologies of the mitral and aortic valves post-TAVR and transcatheter edge-to-edge repair. (C) The mitral valve dual orifice areas measured by transoesophageal echocardiography were 2.04 cm2 and 1.31 cm2, respectively. The red stars in Figure depict the dual orifice areas of the mitral valve. (D) Transoesophageal echocardiography showed mild paravalvular regurgitation of the aortic valve after TAVI and TEER, with resolution of MR. The maximum transvalvular pressure gradient across the mitral valve was 3 mmHg, with a mean pressure gradient of 1 mmHg. (E,F) The transcatheter heart valves used were the J-Valve (JieCheng Medical, China) for the aortic position and the MVC-IIIf mitral valve clip (Shanghai Hanyu Medical, China) for the edge-to-edge repair.
case_images: fcvm-11-1346022-g002.jpg
case_images: PMC10927942_01_fcvm-11-1346022-g002.jpg
case_images: F2
case_images: Aortic root angiography revealed minimal regurgitation around the aortic valve, and the delivery sheath was carefully removed under fluoroscopy (Figure 1D, Figure 2E). Two- and three-dimensional echocardiography confirmed the proper position of the mitral valve clip, with resolution of MR and optimal clip closure, resulting in a maximum transvalvular gradient of 3mmHg and a PGmean of 1 mmHg (Figure 2A,B). The dual orifice areas of the mitral valve, as measured by transesophageal echocardiography, were 2.04 cm2 and 1.31 cm2 respectively (Figure 2D). The mitral valve clip was well-positioned and securely fixed (Figure 2D,F).