Right-to-Left Shunt During Transseptal Mitral Valve-in-Valve Replacement: A Case Report

A A Pract. 2019 Apr 1;12(7):226-230. doi: 10.1213/XAA.0000000000000890.


The following case report details an 88-year-old woman with severe mitral stenosis and moderate mitral regurgitation who presented with worsening dyspnea on exertion. The patient had undergone 4-vessel coronary artery bypass graft and mitral valve replacement 14 years before and was deemed high risk for redo sternotomy. A transseptal mitral valve-in-valve replacement was performed which resulted in intraoperative hypoxia and hypotension after atrial septal defect creation for valve deployment. A right-to-left shunt had developed due to the patient's underlying pulmonary hypertension. Successful atrial septal defect closure resolved the hypoxia and hypotension. The patient had a brief and uncomplicated postoperative course.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Female
  • Heart Septal Defects, Atrial / complications*
  • Heart Septal Defects, Atrial / surgery
  • Heart Valve Prosthesis Implantation / adverse effects*
  • Humans
  • Hypotension / complications*
  • Hypoxia / complications*
  • Intraoperative Complications*
  • Mitral Valve / surgery*