Transcatheter aortic valve implantation after previous mechanical mitral valve replacement in a patient with coexistent rheumatic aortic stenosis and regurgitation

A 67-year-old female was referred to our center with rheumatic aortic stenosis (AS) and aortic regurgitation (AI). As the patient was a high-risk case for surgery, we chose transcatheter aortic valve implantation (TAVI) as the treatment of choice. However, the thickened, long, and mildly calcified aortic valve, and the very small distance (7 mm) between the aortic annulus and mechanical mitral valve (MMV) increased the risk of coronary artery occlusion and flap clamping of MMV. As the left ventricle was small in size, transfemoral TAVI, which causes lesser degree of trauma to the patient, was successfully performed eventually.