Page 38 - Journal of Structural Heart Disease Volume 1, Issue 3

Original Scientific Article 144
Figure 4. Transcatheter bicaval valve implantation. A. Fluoroscopy - Right atrial angiography: The inferior vena cava (IVC) valve is designed with the upper segment protruding into the right atrium (RA), the superior vena cava (SVC) device is funnel shaped to facilitate anchoring at the cavoatrial junction. Contrast is retained at the level of the valved stents. RA: right atrium; SVC: superior vena cava; IVC: inferior vena cava. B. Transoesophageal echocardiography: long-axis view of the IVC device after deployment. C. Post mortem specimen macroscopic view: the valved stents are securely anchored with the stent struts covered by fibrous tissue, fixing the devices.
Valve-in-Ring Therapy
Based on the principle of valve in valve, a com- pletely rigid annuloplasty ring may also offer ade- quate anchoring support and landing zone. The first experiments were performed for the mitral valve. In an animal study, Kempfert et al. [28] showed that an off-pump transatrial transcatheter valve in ring im- plantation using 23-mm Edwards Sapien® valve in a 26-mm Physio® mitral ring was feasible with good heamodynamic results. One main concern was the oval shape of the Physio® ring versus the circular
shape of the Sapien® valve. However, in bench test- ing, authors demonstrated the adaptability of the Physio® ring into a circular form at balloon insuffla- tions. Subsequently, several papers reported mitral valve-in-ring implantation through a left ventricular trans apical approach in compassionate-use proce- dures for patients with high surgical risk [29, 30]. In- deed, the first in man implantation of a transcatheter valve in a mitral annuloplasty ring was performed in a 72-year-old man with ischemic heart failure (ejec- tion fraction 35%) and severe mitral regurgitation. A 26-mm Sapien-Edwards aortic valve was successfully
Journal of Structural Heart Disease, August 2015
Volume 1, Issue 3: 137-151