P118 DEGENERATION OF PROSTHETIC HEART VALVES: EXCITING CHALLENGE IN CATH LAB

Abstract Background Prosthetic Heart Valves are always more frequent in the clinical practice. Particularly, sometimes than one native valve is affected and needs to be surgically treated. On other side, replaced prosthesis could also degenerate over time, leading worsening symptomatic heart failure. There no many cases of combined percutaneous approach both aortic mitral prosthetic deterioration: our aim display a case this complex setting. Case: A 76–year–old man with previous surgical replacement, respectively through Hancock (27 mm) Mitroflow (21 mm), was referred Centre for dyspnoea on mild efforts. Echocardiography revealed severe degeneration valves, moderate stenosis (mean pressure gradient – MG 6 mmHg) central regurgitation, high transaortic gradients (MG 58; peak PG 103 mmHg). Pulmonary hypertension, right ventricle dysfunction reverse flow hepatic veins were evident. Results The first intervention Valve–in–Valve Transcatheter Aortic Valve Implantation (ViV TAVI) CoreValve Evolut PRO+ (23 followed however by recoil determining 25, 47 Hence, as left valves needed treatment, we decided plan an elective procedure aimed treat them. ViV cracking successfully obtained non–compliant Atlas Gold Balloon (22 mm). Then, transseptal puncture Brockenbrough needle SL0 dilator sheath system used gain access atrium. Finally, after interatrial shunt pre–dilation, Edwards Sapien 3 Ultra (26 applied Mitral during rapid pacing. showed relevant decrease 11, 19) downgrading regurgitation from mild, despite unvaried persistent signs chronic pulmonary hypertension. patient dismissed days, adjusting medical therapy. Conclusions Dysfunction challenging approached, particularly when involving one. expertise assumes great importance delicate More explanations further define type timing treatment multiple valves.