Endovascular repair of iliac vein perforation during trans-septal mitral valve-in-valve replacement: a case report.
Journal
European heart journal. Case reports
ISSN
2514-2119
Date Issued
2025-11
Author(s)
Abstract
Background Transcatheter mitral valve-in-valve (TMViV) replacement via trans-septal access is a less invasive alternative for high-risk patients with degenerated bioprosthetic valves. However, life-threatening venous injuries may occur, though they are rarely reported. Case summary A 73-year-old man with a prior mitral bioprosthetic valve replacement presented with heart failure due to severe prosthetic stenosis. TMViV was planned via a trans-septal approach. During device advancement through the right iliac vein, a massive venous perforation occurred, resulting in haemorrhagic shock. The cause was likely unrecognized venous calcification. Emergent endovascular repair with covered stents successfully stabilized the patient. Discussion This case highlights the risk of catastrophic venous complications during trans-septal TMViV procedures, particularly in patients with venous calcification. Prompt recognition and endovascular intervention can be life-saving in such rare but critical scenarios. © 2025 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology.
Subjects
Case report
Endovascular repair
Iliac vein perforation
Trans-septal mitral valve-in-valve replacement
Type
journal article