2024 FSA Podium and Poster Abstracts

P051: VALVE IN VALVE REPLACEMENT IN THE TREATMENT OF SEVERE MITRAL STENOSIS
Marialla Inoyatov; Samantha Arzillo Garner; Scott Golden; HCA Westside

Mitral stenosis is a common cardiovascular disease that possesses a significant morbidity worldwide. Treatments that aim to increase the area of the mitral valve effectively improves morbidity and mortality. This can be accomplished in a post-operative setting. Mitral valve stenosis can significantly compromise cardiovascular function, leading to a myriad of symptoms and complications. The classification of mitral stenosis commonly relies on the extent of valve opening and the resultant pressure gradient. Severe mitral stenosis is often denoted by a valve area below 1.0 square centimeters and elevated pressure gradients exceeding 10 mmHg, signifying high resistance and turbulent blood flow. Traditional treatments like open-heart surgery may not be viable for all patients, prompting exploration of less invasive alternative strategies. Valve-in-valve replacement has become a viable therapeutic approach. This option gives surgeons another weapon in the battle against the challenges offered by severe mitral stenosis. Transcatheter mitral valve replacement in practice is currently focused on the treatment of patients with severe failure and stenosis of bioprosthetic valves. The procedure helps restore normal blood flow, thus alleviating the hemodynamic burden. Particularly beneficial for high-risk surgical candidates, the valve-in-valve approach presents a less invasive yet effective means of addressing severe mitral stenosis compared to traditional treatment options. 

Our case describes a 51 year old Male who presented with shortness of breath after a recent inflenza infection. Imaging revelead a large pleural effusion which subsequently got drained. Further cardiac workup revealed that the patient had severe mitral stenosis with a bioprosthetic valve in place from previous open heart surgery. An echo revealed an ejection fraction of 80%, RVSP of 60, dilated left atrium, mild AI, moderate TR, moderate PI. Decision was made to take patient for transcather mitral valve replacement. Being that the patient concomitantly had respiratory distress requiring high flow nasal canula great concern was had for his tolernace of induction of anesthesia. Multidisciplinary discussion led to a plan of potential ECMO initiation should the patient not tolerate induction of anesthesia. The patient successfuly underwent the procedure with even immediate improvement of his pulmonary artery pressures. This case report aims to descrinbe the challenges of valve in valve repair for the anesthesia team and what considerations were taken place to ensure a successful procedure with good patient outcome.