Transfemoral valve-in-MAC implantation due to severe radiation-induced mitral stenosis

Abstract

To the Editor, This is the case of a 57-year-old man with a past medical history of thoracic radiation in his adolescence in the context of Hodgkin’s lymphoma. The patient also has unclassified interstitial lung disease and endothoracic goitre with tracheal displacement creating a difficult airway. Back in 2014, the patient was diagnosed with chronic coronary syndrome and complete percutaneous revascularization of right coronary artery was achieved. The echocardiograms revealed the presence of severe mitral valve stenosis due to valve calcification without signs of rheumatic disease, preserved systolic function, and severe pulmonary hypertension. The patient started showing progressive signs of heart failure, and aortic valve replacement was indicated. Given the evidence of porcelain aorta, transcatheter aortic valve implantation (TAVI) was decided using a 23 mm Edwards SAPIEN valve (Edwards Lifesciences, United States) under deep sedation via femoral access. No complications were reported at discharge. Follow-up in the valve clinic showed progressive worsening of dyspnea (New York Heart Association [NYHA] class III). Additional tests confirmed the progression of mitral stenosis. The transthoracic (TTE) and transesophageal (TEE) echocardiography confirmed the presence of extensive mitral annular calcification (MAC) causing severe mitral stenosis (mean gradient, 15 mmHg) without regurgitation, mild right ventricular dilatation with preserved function, and...