Valve-In-Valve–Tavi Procedure in Multivalvular DiseaseFuture Perspectives on Young Patients

Young patients with rheumatic disease almost invariably develop the multivalvular disease. In general, patients with multivalvular disease are more severely for conventional surgical procedures. With the advent of less invasive transcatheter treatment, patients with more than one valve disease are part of the Heart Team's discussion, so that their peculiarities are better understood.A 32-year-old, female patient refers that without having performed any physical effort, he suddenly felt short of breath during walks with a very fast “pulse” and “gasping” when talking.The patient had undergone multivalvular surgery 16 years ago: replacement of the aortic valve with a biological prosthesis (23 mm), and mitral valve annuloplasty with a prosthetic ring (26 mm).Clinical examination showed a pale patient, breathless, and tachycardic. BP: 130 x 55 mmHg, HR: 100 b x min. He had a systolic murmur ++/4+; a diastolic murmur ++/4+, in aortic focus.Doppler echo images showed significant aortic regurgitation, with a flap from one of the cusps of the prosthesis, prolapsed into the cavity of the left ventricle and mild mitral regurgitation. The final diagnosis was: a rupture of the biological aortic prosthesis, followed by acute aortic insufficiency, after the 16th year of follow-up.The patient underwent aValve in Valve (ViV) - TAVI procedure. A Sapien 3 ultra valve, measuring 23 mm, was implanted through a femoral approach inside the dysfunctional biological prosthesis. The procedure was performed successfully, and the patient was discharged from the hospital 2 days later