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A 67-year-old female with Hodgkin’s disease was treated with radiation therapy at age 17, had chronic lymphocytic leukemia, breast cancer status post-bilateral mastectomies in 2000, partial nephrectomy, chronic kidney disease, deep venous thrombosis, pulmonary emboli on chronic anticoagulation, radiation-induced valvular heart disease, prior aortic valve replacement with a 21 mm Hancock II valve in 2009, pacemaker placement, chronic obstructive pulmonary disease on home oxygen therapy and moderate non-obstructive single vessel coronary artery disease with 60% stenosis of mid left anterior descending artery. She presented with symptomatic severe mitral stenosis and severe mitral annular calcification (MAC). She was New York Heart Association (NYHA) class III heart failure and transthoracic echocardiogram showed a mitral valve area of 1.2 cm with a mean mitral gradient of 11 mmHg. Although her Society of Thoracic Surgery predicted risk of mortality score for reoperation for mitral valve replacement alone was 6.49%, she was considered to have extreme surgical risk due to her multiple medical comorbidities, porcelain aorta, hostile chest and the presence of severe MAC. She was referred for possible transcatheter mitral valve replacement (TMVR).

Transseptal transcatheter mitral valve replacement in severe mitral annular calcification (transseptal valve-in-MAC)