Objective: The surgical treatment of severe mitral regurgitation concomitant with dilated cardiomyopathy (DCM) is challenging because of poor heart function. Herein, we have reported a successful transcatheter mitral valve-in-valve (TM-ViV) implantation (valve-in-valve procedure) in a heart transplant candidate.

Case Presentation: A 66-year-old man who suffered from DCM underwent mitral valve replacement for mitral regurgitation 7 years ago and was registered as a candidate for heart transplantation (status 2) at 65 years of age. He suffered from dyspnea on effort (New York heart association functional classification (NYHA) III) and his echocardiography revealed prosthetic mitral valve dysfunction (severe regurgitation). Because the surgical risk for prosthetic valve dysfunction was high (society of thoracic surgeons (STS) score: 11.2%), he was enrolled for on-pump TM-ViV procedure. The intraoperative and postoperative courses were uneventful, and echocardiography at the 18-month follow-up revealed low mean pressure gradient (4.2 mmHg) transmitral bioprosthesis and no paravalvular leakage.

Conclusions: On-pump transcatheter mitral valve implantation may be an important treatment option for severely injured left ventricular (LV) function with a failed bioprosthesis.

Objective: MitraClip is currently indicated for symptomatic severe mitral regurgitation (MR) in surgical high-risk patients. After the MitraClip procedure, single leaflet device attachment and device embolization appear as potential risks that have yet to be clarified. We present a case with occult single leaflet device attachment followed by late device embolization.

Case Presentation: A 60-year-old man presented with severe symptomatic MR due to wide prolapse of the posterior leaflet, resembling Barlow syndrome. Medical history included pancreatic cancer (Stage IVb) at 52 years old, and lung metastases at 59 years old. He became aware of heart failure symptoms due to MR and surgery was indicated. After a multidisciplinary heart team conference, the decision was made to perform the MitraClip procedure. During the MitraClip procedure, attempted placement of the second clip interfered with the chorda tendineae, control of the clip was lost and both clips became entangled. Eventually, two clips were placed, and MR improved to a mild degree, but stability of the first clip was insufficient. Five months later, the first clip became detached from the posterior leaflet. At 6 months after the procedure, the clip had dropped to the inferior wall of the left ventricular. We diagnosed clip embolization of the first clip, performed emergency open heart surgery.

Conclusion: Clip instability may impose a higher risk of clip embolization in the MitraClip procedure. We recognized not only reduction of MR but also clip stability as important factors to determine success of the MitraClip procedure, particularly with degenerative MR.

Objective: Combinational hybrid therapies with transcatheter aortic valve implantation (TAVI), including simultaneous TAVI and off-pump coronary artery bypass (OPCAB), have become new options for patients with high surgical risk with severe aortic stenosis (AS) and concomitant coronary artery disease or other valvular disease. While quadricuspid aortic valve (QAV) is a rare congenital abnormality often associated with aortic regurgitation, only a small percentage of patients present with AS. Thus, the usefulness and technical features of TAVI for AS in QAV are not well established. We report a Japanese woman with a stenosed QAV and concomitant coronary artery disease, who was successfully treated by simultaneous transaortic TAVI and OPCAB.

Case presentation: An 86-year-old woman with multiple comorbidities presented with acute decompensated heart failure. Transthoracic echocardiography showed severe AS, and the patient was noticed to have QAV by preoperative computed tomography (CT) and transesophageal echocardiography. Coronary angiography revealed multiple coronary artery stenoses in the left main trunk, left anterior descending, and right coronary arteries. She was successfully treated by simultaneous transaortic TAVI and OPCAB using a 26-mm CoreValve.

Conclusion: We report a case of stenosed QAV with concomitant coronary artery disease and high surgical risk, successfully treated by simultaneous transaortic TAVI and OPCAB. TAVI for AS in QAV, as well as combinational hybrid therapies with TAVI, may be reasonable options for patients with high surgical risk.

Objective: Transcatheter aortic valve implantation (TAVI) is an established therapy for aortic stenosis (AS). However, concomitant hypertrophic obstructive cardiomyopathy (HOCM) was associated with substantially worse in-hospital outcomes including cardiogenic shock, renal failure, and death in patients undergoing TAVI. Furthermore, there were few reports on optimal management for AS complicated with HOCM. In this case, we report a Japanese man with severe AS and concomitant HOCM, who was successfully treated by TAVI following PPM implantation.

Case Presentation: An 87-year-old man with severe AS and HOCM transferred to our institution for treatment. We were concerned that abrupt afterload decrease and complete atrioventricular (AV) block during the TAVI procedure would introduce hemodynamic collapse due to left ventricular outflow obstruction (LVOTO). Our heart team decided the strategy of permanent pacemaker (PPM) implantation followed by TAVI with optimal medication. After PPM implantation, the TAVI procedure via transfemoral approach could be performed safely without deterioration of LVOTO. He was discharged 4 days after TAVI procedure without any symptoms.

Conclusion: Transfemoral TAVI following PPM implantation was safety and useful strategy for severe AS complicated with HOCM.