Transesophageal-echocardiography-guided one-stage TAVR + M-TEER credibly treated patients with severe double valve regurgitation: a case report.

Abstract

Background: There are few reports about the one-stage surgery of transcatheter aortic valve replacement (TAVR) + mitral valve transcatheter edge-to-edge repair (M-TEER) around the world. TAVR + M-TEER surgery is usually performed under the simultaneous guidance of digital subtraction angiography (DSA) and echocardiography. There is no report of TAVR surgery assisted only by echocardiography all over the world. This case shows a novel one-stage transesophageal echocardiography-guided TAVR + M-TEER surgery, which provides a new idea for minimally invasive therapy.

Case description: A 75-year-old man with recurrent chest tightness was diagnosed with bicuspid aortic valve malformation and severe regurgitation of aortic and mitral valves. The symptom was not relieved by medications. After evaluation with transthoracic echocardiography and computerized tomography angiography (CTA) of the aorta, transapical TAVR and M-TEER were performed simultaneously with satisfied clinical results. The patient's activity tolerance and cardiac function were improved.

Conclusions: In the past, this surgery needs to be performed in a specific operating room equipped with an X-ray machine, and there are many steps in the whole procedure that requires more medical staff. Transesophageal echocardiography-guided minimally invasive valvular surgery reduces the reliance on the hybrid operating room, mitigates the impact of radiation on physicians and patients, and also provides a treatment chance for gravidas with valvular disease.