Sehgal, SankalpSubramanyam, PrithaAhluwalia, MonicaRastogi, AshishBergman, Geoffrey2023-07-142023-07-142023-06Sehgal Sankalp, Subramanyam Pritha, Ahluwalia Monica, Rastogi Ashish, Bergman Geoffrey. Transcatheter Mitral Valve Implantation: Implications of Interventional Technique and 3D Echocardiography for Complex Valve?in?Valve Paravalvular Leak. International Journal of Medical Research & Health Sciences. 2023 Jun; 26(2): 227-2310974-51810971-9784http://imsear.searo.who.int/handle/123456789/219304Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve?in?valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve?in?valve PVL are limited. We present a case of a symptomatic patient with severe valve?in?valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve?in?valve?in?valve implantation with a 29 mm Edwards? SAPIEN 3 valve via transseptal approach using three?dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve?in?valve PVL closures.echocardiographyThree?dimensional echocardiographymitral regurgitationmitral valveparavalvular leakTMVRtranscatheter mitral valve repairtransesophageal echocardiographyJournal ArticleIndiaDepartment of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Cardiothoracic Anesthesia, Critical Care and Pain Medicine, 330 Brookline AveBoston Medical Center, Boston University School of Medicine, Division of Cardiovascular Medicine, 72 E. Concord St, Boston, MAWeill Cornell Medical College, New York Presbyterian Hospital, Division of Cardiology, 525 E. 68th Street, New York, NYOwensboro Health Cardiology, 1301 Pleasant Valley Road, Owensboro, KY