Successful mitral valve-in-ring repair of mitral annuloplasty ring dehiscence causing severe mitral regurgitation: a case report

BACKGROUND: Annuloplasty failure caused by ring dehiscence can lead to trans-ring and para-ring mitral regurgitation (MR). Transcatheter treatments are available for patients at prohibitive risk of surgery. In patients unsuitable for edge-to-edge repair, valve-in-ring (ViR) transcatheter mitral valve (MV) implantation has been described to treat trans-ring or para-ring jets but not both concurrently. CASE SUMMARY: A 78-year-old male presented with severe MR due to dehiscence of a 34 mm Edwards Physio II mitral annuloplasty ring. Transoesophageal echocardiography showed two jets of regurgitation; trans-ring and para-ring. Repair was successfully undertaken with a ViR procedure (29 mm S3 Edwards Lifesciences). DISCUSSION: Patients with failure of MV annuloplasty with trans-ring and para-ring regurgitation can be safely and effectively treated by ViR transcatheter MV implantation.