Transseptal Access Through Prior Atrial Septal Occluder Device for TMVR for Prosthetic Mitral Valve Degeneration

Background: Transseptal access is critical for transcatheter mitral valve replacement (TMVR), but prior septal occlusion can complicate reinterventions. Case Summary: A 62-year-old woman with dyspnea and severe mitral stenosis of a degenerated M3 bioprosthetic valve underwent valve-in-valve TMVR with access achieved through a previously implanted 30-mm Cardioform Septal Occluder using an electrocauterized wire and Brockenbrough needle, followed by balloon dilatations. A 29-mm SAPIEN 3 valve was implanted, reducing the mitral gradient from 19 to 2 mm Hg. A residual left-to-right shunt was left untreated. The patient was discharged the next day without complications. Discussion: TMVR with a balloon-expandable TAVR platform can be performed safely and effectively through a Cardioform Septal Occluder and is facilitated by predilatation of the Cardioform Septal Occluder with a large balloon. Take-Home Message: Transseptal access through a Cardioform Septal Occluder is feasible for valve-in-valve TMVR. Awareness of strategies to manage prior interatrial septum closures is crucial as repeat mitral interventions become more common.