EchoNavigator®-guided transcatheter mitral valve-in-valve procedure to treat a degenerated radiolucent surgical bioprosthetic valve: a case report

Background Radiolucent valves present unique clinical challenges since interventions often depend on multiple imaging modalities to perform such procedures successfully. EchoNavigator (R) is novel imaging software that specializes in real-time merging ultrasound and fluoroscopy images. It addresses these limitations by simultaneously integrating the benefits of two imaging modalities.Case summary An 85-year-old man with a history of bioprosthetic valve disease developed life-limiting symptoms. Transesophageal echocardiogram (TEE) showed severe bioprosthetic mitral stenosis, prompting plans to perform a transcatheter mitral valve-in-valve (TMVIV) replacement. Using EchoNavigator (R) to mark the annulus on TEE, we were able to successfully deploy the valve using fluoroscopy to guide the successful deployment of the valve.Discussion The treatment of degenerated valves using transcatheter valve-in-valve procedures has increased in frequency recently due to increasing age and comorbidities associated with patients. Identifying the true annulus plays an integral role in ensuring the valve is deployed in the ideal location. However, the radiolucent nature of the valve prohibits performing a TMVIV under conventional methods. Utilization of fusion imaging, such as EchoNavigator (R), provides an opportunity to visualize such valves using the strengths of both modalities simultaneously, simplifying such procedures. To our knowledge, this is the first report of using such fusion technology to facilitate the placement of a bioprosthesis within a failed radiolucent surgical valve. Application of such technologies can help improve the performance and outcomes of such procedures by allowing operators to use the advantages of both imaging for improved outcomes.