Objective: As the number of transcatheter aortic valve implantation (TAVI) procedures increases, specific complications, including aortic dissection, have been reported. Acute type B aortic dissection (ATBAD) is rare but more difficult to detect during TAVI compared to acute type A aortic dissection (ATAAD). This study presents our experience with iatrogenic ATBAD during TAVI.

Methods: General anesthesia combined with transesophageal echocardiography (TEE) is employed during TAVI. After deploying the prosthesis, the descending aorta is routinely assessed for access injury. We identified 4 cases of ATBAD among 175 TAVI procedures performed since 2017.

Results: Preoperative computed tomography (CT) revealed moderate atherosclerosis and angulation of the aortic arch in all 4 patients. Self-expanding prosthetic valves were used, and injury was believed to be caused by the guidewire or device tip during passage through the aortic arch. Postoperative CT showed an uncomplicated type B dissection, and conservative management was successfully implemented without major adverse aortic events.

Conclusion: TEE during TAVI is crucial for detecting iatrogenic aortic dissection. In patients with significant aortic angulation, balloon-expandable valves may offer better flexibility. Stiff guidewires should be carefully maneuvered to avoid intimal damage during the procedure.

Objective: Transcatheter edge-to-edge repair (TEER) is increasingly being used as a minimally invasive treatment option for functional mitral regurgitation (FMR). This study aimed to compare the outcomes of TEER in patients with atrial FMR (a-FMR) and ventricular FMR (v-FMR) and to assess the impact of mitral valve morphology on clinical and procedural outcomes.

Methods: We retrospectively evaluated 125 consecutive patients with FMR who underwent TEER between April 2018 and January 2022. Based on the echocardiography findings, the patients were categorized into a-FMR and v-FMR groups. We compared the procedural and clinical outcomes of TEER between the 2 groups and assessed the influence of the mitral valve apparatus on these results.

Results: Patients with a-FMR were significantly older and comprised a higher proportion of women, while those with v-FMR demonstrated significantly lower left ventricular ejection fraction and larger left ventricular diameter. There were no significant differences in the procedural outcomes or major adverse cardiovascular events (MACE) between the a-FMR and v-FMR groups within a year. In a-FMR, atriogenic tethering was identified as a predictor of residual MR. However, there were no significant differences in MACE according to the presence or absence of atriogenic tethering.

Conclusion: The results of this study suggest that TEER is a safe and effective treatment for a-FMR. Nonetheless, evaluating mitral valve morphology remains crucial as it can influence procedural outcomes.

Objective: We report a rare case of severe hemolytic anemia caused by residual paravalvular leak (PVL) following transcatheter aortic valve implantation (TAVI), which ultimately required surgical aortic valve replacement (AVR).

Case Presentation: A 77-year-old man underwent transfemoral TAVI using a 23-mm SAPIEN 3 Ultra RESILIA valve (Edwards Lifesciences, Irvine, CA, USA) at another institution. Mild residual PVL was identified intraoperatively. After 2 months, he developed progressive anemia with elevated lactate dehydrogenase and bilirubin levels, consistent with mechanical hemolysis. Despite repeated blood transfusions, his symptoms worsened, and he was referred to our hospital. Imaging revealed mild PVL at the left/noncoronary commissure. Considering worsening hemolysis, surgical intervention was indicated. The TAVI valve was explanted via median sternotomy, and AVR was performed. His anemia resolved postoperatively, and he was discharged on postoperative day 15 without recurrence.

Conclusion: Even mild PVL after TAVI can, in rare circumstances, cause clinically significant hemolytic anemia that necessitates surgical revision. As the use of TAVI increases, awareness of this complication is essential for early diagnosis and timely intervention.

Objective: Transcatheter valve-in-valve pulmonary valve implantation (ViV-TPVI) with SAPIEN 3 (Edwards Lifesciences, Irvine, CA, USA) is effective for treating insufficient prosthetic valves in right ventricular outflow tract diseases. SAPIEN 3 is primarily used to replace failed aortic valves; therefore, there is limited published data on the outcomes of its use for ViV-TPVI. In patients with severe heart failure, every procedure can lead to collapse during TPVI. This case report aims to describe the procedural strategy, perioperative management, and short-term outcomes of ViV-TPVI with SAPIEN 3 in a patient with biventricular heart failure, where careful preparation and prerisk assessment were critical to procedural success.

Case Presentation: A 19-year-old Asian female patient was diagnosed with 22q11.2 deletion syndrome, double outlet right ventricle, and pulmonary stenosis during childhood. She underwent several surgical repairs, including pulmonary valve replacement with a Carpentier-Edwards PERIMOUNT Magna Ease 21 mm at age 10 years. A postsurgical echocardiogram 7 years after the last surgery showed a mean pressure gradient across the pulmonary valve of 46 mmHg, which exceeded the 35-mmHg threshold for TPVI indication. Catheterization showed worsening pulmonary stenosis with an elevated pressure gradient up to 30 mmHg and markedly reduced biventricular heart contraction, with right and left ventricular ejection fractions of 15% and 39%, respectively. She subsequently underwent successful ViV-TPVI with SAPIEN 3, which resulted in symptomatic improvement and reduction in pulmonary valve pressure gradient.

Conclusion: We present a successful case of ViV-TPVI using SAPIEN 3 in a patient with severe biventricular heart failure and favorable early outcomes.

Objective: The self-expanding valves used in transcatheter aortic valve implantation (TAVI) feature the ability to be recaptured before reaching the point of no recapture. We report a rare case of TAVI for surgical aortic valve dysfunction in which a self-expanding Evolut FX valve (Medtronic, Minneapolis, MN, USA) could not be recaptured and was consequently deployed in the abdominal aorta.

Case Presentation: The patient was an 84-year-old male with a history of 2 previous surgical aortic valve replacements. He underwent transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV) for dysfunction of a bioprosthetic valve (Mosaic 21 mm; Medtronic) implanted approximately 18 years prior. During the deployment of a self-expanding Evolut FX 23-mm valve, it became impossible to recapture the device during the third repositioning attempt. Despite attempts to recapture the valve and remove it from the body, it was ultimately deployed in the abdominal aorta. Fortunately, blood flow to major branches, such as the superior mesenteric artery, was preserved, and no obvious circulatory compromise was observed. Subsequently, the second valve was successfully deployed in the intended position.

Conclusion: We experienced a valuable case of TAV-in-SAV where a self-expanding aortic valve became impossible to recapture and was deployed in the abdominal aorta. Multiple contributing factors were suspected, including issues with the coaxiality of the device and the Evolut valve, interference between the surgical bioprosthesis and the Evolut valve, and the frame deformation. To our knowledge, no similar cases have been reported, and we present this case for its clinically important implications.

Objective: Severe tricuspid regurgitation (TR) is linked to poor prognosis, and transcatheter edge-to-edge repair (Tricuspid-TEER) has become a promising therapeutic option. However, intraprocedural imaging remains challenging. While transesophageal echocardiography (TEE) is the standard, it may not always provide optimal visualization and can cause esophageal injury.

Case Presentation: In this preclinical study using a 3-dimensional-printed human heart model, intracardiac echocardiography (ICE) was evaluated as a complementary imaging tool. Specific catheter rotations enabled precise visualization of individual tricuspid leaflets, facilitating accurate procedural guidance.

Conclusion: Combining ICE with TEE may enhance real-time imaging, reduce procedural time, and minimize injury risk during tricuspid TEER, supporting its role as an adjunctive modality in future procedures.