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Right-to-Left Shunt During Transseptal Mitral Valve-in-Valve Replacement

A Case Report

Latimer, Ryan, MD, MSc; Gilly, George, MD

doi: 10.1213/XAA.0000000000000890
Case Reports

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.

From the Department of Anesthesiology, Ochsner Health Systems, New Orleans, Louisiana.

Accepted for publication August 10, 2018.

Funding: None.

The authors declare no conflicts of interest.

Address correspondence to Ryan Latimer, MD, MSc, Department of Anesthesia, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA 70121. Address e-mail to

© 2019 International Anesthesia Research Society
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