PMC3946467_01
a - Shows preprocedure severe mitral regurgitation through a large PVL, b - Shows post procedure mild residual mitral regurgitation.
gr1.jpg
PMC3946467_01_gr1.jpg
fig1
The associated mitral regurgitation was severe (Fig. 1a) with dilated left atria (measuring 68 mm in parasternal long axis view) and left ventricle with mild left ventricular (LV) systolic dysfunction (LV ejection fraction of 45%). He was fine at 1-year follow up with significant improvement in his symptoms to NYHA functional class II and minimal residual MR (Fig. 1b).
Two 032 wires have been taken through the PVL and then across the aortic valve and parked in the subclavian artery (not seen in figure). The sheath can be seen having been tracked over the wires through the PVL into the LV.
gr2.jpg
PMC3946467_01_gr2.jpg
fig2
The 14F sheath could now be taken across the PVL, over these two wires, without any resistance (Fig. 2).
Distal rims of both devices have been opened in the LV simultaneously to prevent the devices from slipping back into the LA.
gr3.jpg
PMC3946467_01_gr3.jpg
fig3
The first device was resheathed and the 14F sheath was lodged across the PVL in the LV with both the devices (Fig. 3).