Paolo Pagnotta, MD, Marco G

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A Hybrid Double Access for Transcatheter Mitral Valve-In-Valve Implantation Paolo Pagnotta, MD, Marco G. Mennuni, MD, Giuseppe Ferrante, MD, PhD, Diego Ornaghi, MD, Renato Bragato, MD, Antioco Cappai, MD, Patrizia Presbitero, MD The Annals of Thoracic Surgery Volume 99, Issue 6, Pages e149-e150 (June 2015) DOI: 10.1016/j.athoracsur.2015.02.101 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Three-dimensional transesophageal echocardiography (TEE). (B) Long-axis TEE view showing prosthesis dysfunction. (C) Doppler trace showing high (12 mm Hg) mean transvalvular gradient. (D) A hydrophilic floppy guidewire successfully crossed the mitral bioprosthesis from the transseptal approach and was then externalized with a Gooseneck snare into the left ventricle. (E) Implantation of a 26-mm SAPIEN XT valve. (F) Final color Doppler TEE showing mild paravalvular regurgitation. The Annals of Thoracic Surgery 2015 99, e149-e150DOI: (10.1016/j.athoracsur.2015.02.101) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions