Kim Sahri, Koo Hyun Jung, Ahn Jung-Min, Song Jae-Kwan, Park Duk-Woo, Yoo Jae Suk
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea.
JACC Case Rep. 2025 Aug 6;30(22):104565. doi: 10.1016/j.jaccas.2025.104565.
The presence of preexisting mitral prosthesis in transcatheter aortic valve replacement (TAVR) raises concerns about potential valve interaction; however, this issue remains insufficiently explored.
A 79-year-old man presented with hemolysis 8 months post-TAVR. He had a history of mitral valve replacement 16 years prior. Further investigation revealed severe paravalvular leakage of the mitral valve, which was attributed to the dehiscence of the mitral prosthesis. A retrospective review of pre-TAVR computed tomography images identified a subtle, previously undetected defect in the mitral-aortic intervalvular fibrosa, likely masked by neointima.
We hypothesize that chronic mechanical stress between the TAVR device and the mitral-aortic intervalvular fibrosa causes progressive damage, resulting in delayed mitral valve dehiscence and hemolysis.
TAKE-HOME MESSAGE: Careful preprocedural evaluation and prolonged postprocedural surveillance are essential for patients with preexisting mitral prostheses after TAVR due to the potential for delayed long-term complications.
经导管主动脉瓣置换术（TAVR）中存在预先置入的二尖瓣人工瓣膜引发了对潜在瓣膜相互作用的担忧；然而，这一问题仍未得到充分研究。
一名79岁男性在TAVR术后8个月出现溶血。他16年前有二尖瓣置换病史。进一步检查发现二尖瓣存在严重瓣周漏，这归因于二尖瓣人工瓣膜的瓣周裂开。对TAVR术前计算机断层扫描图像的回顾性分析发现二尖瓣 - 主动脉瓣间纤维组织存在一个细微的、先前未被发现的缺陷，可能被新生内膜掩盖。
我们推测TAVR装置与二尖瓣 - 主动脉瓣间纤维组织之间的慢性机械应力会导致渐进性损伤，从而导致二尖瓣瓣周裂开和溶血延迟出现。
由于存在延迟出现长期并发症的可能性，对于TAVR术后存在预先置入二尖瓣人工瓣膜的患者，仔细的术前评估和延长的术后监测至关重要。
