First Reported Case of Transcatheter Mitral Valve Implantation in Mitral Annular Calcification With a Fully Repositionable and Self-Expanding Valve

Mitral valve intervention in heavy mitral annular calcification (MAC) presents significant surgical challenges. Current dedicated transcatheter mitral valve therapy excludes patients with significant MAC. Transcatheter aortic valve implantation devices have been used for mitral valve-in-valve and valve-in-ring procedures.1 Balloon-expandable valves have been used with some success in the presence of MAC, but their use is limited by the inability to reposition if left ventricular outflow tract (LVOT) obstruction occurs.2 We describe 2 cases, where a self-expanding and repositionable transcatheter valve was implanted in the mitral position using MAC as an anchor. A 75-year-old woman presented with increasing breathlessness after her aortic valve replacement and mitral valve repair in 2014. Echocardiography demonstrated a functioning prosthetic aortic valve and severe mitral regurgitation. The mitral annulus had a measured perimeter of 77 mm and area of 400 mm2 (transesophageal echocardiography) with an aortomitral annular angle of 124° (computed tomography). A 62-year-old man presented with New York Heart Association III symptoms. Medical history included Alport syndrome, transcatheter aortic valve implantation (26 mm Sapien XT), and permanent pacemaker. Echocardiography demonstrated a functioning prosthetic aortic valve and severe mitral regurgitation. The mitral annulus had a measured perimeter of 82 mm …