{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:46:27Z","timestamp":1785739587421,"version":"3.56.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":213,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Cardiology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Transcatheter valve\u2010in\u2010valve mitral valve replacement (ViV TMVR) is an established therapeutic alternative for selected patients with symptomatic degeneration of a surgical mitral bioprosthesis and high or prohibitive surgical risk. We present a 75\u2010year\u2010old woman with a failed Pericarbon More 29\u2010mm mitral bioprosthesis and severe prosthetic mitral stenosis, which was resolved with transseptal transcatheter ViV TMVR. Baseline echocardiography showed mitral valve area 0.45\u2009cm\n                    <jats:sup>2<\/jats:sup>\n                    by pressure half\u2010time, mean transmitral gradient 13\u2009mmHg, preserved left ventricular systolic function, estimated systolic pulmonary artery pressure of 55\u2009mmHg, and severe tricuspid regurgitation. ECG\u2010gated computed tomography was performed for proper procedural planning. During the procedure, after dilation of the interatrial septum, an abrupt left\u2010to\u2010right shunt caused hemodynamic compromise. Rapid rescue balloon dilation of the stenotic mitral bioprosthesis and subsequent implantation of a 26\u2010mm SAPIEN 3 valve restored forward transmitral flow, reduced the interatrial shunt to a minimum, and avoided septal occluder implantation. Postprocedural echocardiography showed a mean transmitral gradient of 3.5\u2009mmHg, no intraprosthetic or paravalvular regurgitation, no LVOT obstruction, and a minimal, hemodynamically insignificant residual shunt. At 6\u2010month, 12\u2010month, and 2\u2010year follow\u2010ups, the patient remained asymptomatic with stable prosthetic valve function, although the estimated pulmonary artery pressure remained mildly to moderately elevated and tricuspid regurgitation persisted at a moderate degree. Beyond demonstrating the feasibility of valve\u2010in\u2010valve TMVR, this case highlights that septal dilation in severe prosthetic mitral stenosis can precipitate abrupt hemodynamic deterioration by creating a clinically significant left\u2010to\u2010right interatrial shunt before relief of the mitral obstruction.\n                  <\/jats:p>","DOI":"10.1155\/cric\/2277200","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T06:19:16Z","timestamp":1785737956000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transcatheter Mitral Valve Replacement in Failed Mitral Bioprosthesis: Case 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