Abstract
BACKGROUND: The presence of preexisting mitral prosthesis in transcatheter aortic valve replacement (TAVR) raises concerns about potential valve interaction; however, this issue remains insufficiently explored. CASE SUMMARY: A 79-year-old man presented with hemolysis 8 months post-TAVR. He had a history of mitral valve replacement 16 years prior. Further investigation revealed severe paravalvular leakage of the mitral valve, which was attributed to the dehiscence of the mitral prosthesis. A retrospective review of pre-TAVR computed tomography images identified a subtle, previously undetected defect in the mitral-aortic intervalvular fibrosa, likely masked by neointima. DISCUSSION: We hypothesize that chronic mechanical stress between the TAVR device and the mitral-aortic intervalvular fibrosa causes progressive damage, resulting in delayed mitral valve dehiscence and hemolysis. TAKE-HOME MESSAGE: Careful preprocedural evaluation and prolonged postprocedural surveillance are essential for patients with preexisting mitral prostheses after TAVR due to the potential for delayed long-term complications.