{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T19:46:47Z","timestamp":1783540007234,"version":"3.55.0"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Severe aortic stenosis (AS) with concomitant mitral annular calcification (MAC) presents substantial procedural and surgical challenges, and simultaneous transcatheter treatment remains rare. This case adds to the emerging literature by demonstrating a hybrid approach using transfemoral transcatheter aortic valve replacement (TAVR) and transapical transcatheter mitral valve replacement (TMVR)-in-MAC supported by patient-specific 3D-printed simulation and prosthesis modification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 68-year-old woman with severe obesity, diabetes, chronic kidney disease, prior thoracic surgery, and a pacemaker presented with progressive dyspnoea. Echocardiography showed severe AS and functional mitral stenosis due to extensive MAC. Given prohibitive surgical risk, the Heart Team pursued a percutaneous strategy. A transfemoral self-expanding aortic transcatheter heart valve (THV) was partially deployed for annular anchoring, followed by transapical TMVR with a balloon-expandable valve modified with a polyethylene terephthalate skirt. Pre-procedural simulation with a patient-specific 3D-printed model guided implant depth and informed the decision for prosthesis modification. Both valves were implanted successfully with no paravalvular leak; a moderate left ventricular outflow tract (LVOT) gradient was noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Simultaneous TAVR and TMVR in MAC is rare and technically challenging. This case shows that patient-specific 3D-printed modelling can support procedural planning and device modification, enabling a feasible hybrid transcatheter strategy with favourable clinical outcomes in a high-risk patient.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag456","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:38:37Z","timestamp":1781613517000},"source":"Crossref","is-referenced-by-count":0,"title":["Simultaneous TAVR and TMVR-in-MAC guided by 3D modelling and prosthesis modification: a case report"],"prefix":"10.1093","volume":"10","author":[{"given":"Yuriy","family":"Pya","sequence":"first","affiliation":[{"name":"Department of Adult Cardiac Surgery, University Medical Center , Turan Ave 38, 010000 Astana ,","place":["Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8581-2959","authenticated-orcid":false,"given":"Yerkezhan","family":"Raissov","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, University Medical Center , Turan Ave 38, 010000 Astana ,","place":["Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serik","family":"Alimbayev","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, University Medical Center , Turan Ave 38, 010000 Astana ,","place":["Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timur","family":"Lesbekov","sequence":"additional","affiliation":[{"name":"Department of Adult Cardiac Surgery, University Medical Center , Turan Ave 38, 010000 Astana ,","place":["Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdurashid","family":"Mussayev","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology, University Medical Center , Turan Ave 38, 010000 Astana ,","place":["Kazakhstan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"2026070814312573000_ytag456-B1","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1016\/j.jacc.2018.02.054","article-title":"1-year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcification","volume":"71","author":"Guerrero","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"2026070814312573000_ytag456-B2","doi-asserted-by":"crossref","first-page":"577","DOI":"10.21037\/atm.2019.09.73","article-title":"Three-dimensional printing in structural heart disease and interventional planning: applications and evidence","volume":"7","author":"Fan","year":"2019","journal-title":"Ann Transl Med"},{"key":"2026070814312573000_ytag456-B3","first-page":"1180","article-title":"Concomitant transcatheter aortic and mitral valve replacement in mitral annular calcification: first-in-human experience","volume":"5","author":"Nagaraja","year":"2023","journal-title":"JACC Case Rep"},{"key":"2026070814312573000_ytag456-B4","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur Heart J"},{"key":"2026070814312573000_ytag456-B5","doi-asserted-by":"crossref","first-page":"e003626","DOI":"10.1161\/CIRCIMAGING.115.003626","article-title":"Replicating patient-specific severe aortic valve stenosis with functional 3D modeling","volume":"8","author":"Maragiannis","year":"2015","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026070814312573000_ytag456-B6","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/j.surg.2015.12.017","article-title":"Advantages and disadvantages of three-dimensional printing in surgery: a systematic review","volume":"159","author":"Martelli","year":"2016","journal-title":"Surgery"},{"key":"2026070814312573000_ytag456-B7","doi-asserted-by":"crossref","first-page":"1361","DOI":"10.1016\/j.jcin.2016.04.022","article-title":"Prospective study of TMVR in MAC: early outcomes from the first 100 patients","volume":"9","author":"Guerrero","year":"2016","journal-title":"J Am Coll Cardiol Intv"},{"key":"2026070814312573000_ytag456-B8","doi-asserted-by":"crossref","first-page":"1492","DOI":"10.1161\/01.CIR.0000058168.26163.BC","article-title":"Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study","volume":"107","author":"Fox","year":"2003","journal-title":"Circulation"},{"key":"2026070814312573000_ytag456-B9","doi-asserted-by":"crossref","first-page":"e018514","DOI":"10.1161\/JAHA.120.018514","article-title":"Surgical mitral valve replacement in patients with MAC: systematic review and meta-analysis","volume":"10","author":"Alexis","year":"2021","journal-title":"J Am Heart Assoc"}],"container-title":["European Heart Journal - 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