Transcatheter Mitral Valve Replacement in Mitral Annular Calcification Using the Novel Myval Valve: Contribution to the Growing Worldwide Experience

Mitral annular calcification (MAC) is a complex structural abnormality often associated with severe mitral stenosis, regurgitation, or both. Mitral valve surgery carries greater risk especially in elderly patients with MAC, making transcatheter mitral valve replacement (TMVR) an emerging alternative. We report the case of an 84-year-old woman with a history of surgical bioprosthetic aortic valve replacement and recurrent hospitalizations due to severe MAC-related mitral valve disease. She was deemed inoperable by the heart team. Detailed multimodal imaging, including multidetector computed tomography (MDCT), revealed extensive MAC with acceptable neo-left ventricular outflow tract (neo-LVOT) dimensions and an acute aorto-mitral angle. Thus, TMVR was successfully performed via a transseptal approach using a 30.5 mm balloonexpandable Myval transcatheter heart valve (THV). Post-procedural imaging confirmed optimal valve position, no paravalvular leak, and no LVOT obstruction. The patient was discharged in stable condition. This is the first reported case from Türkiye of TMVR in MAC using the Myval THV, contributing to the growing worldwide experience. This report also emphasizes the role of advanced imaging in guiding patient selection and procedural planning and illustrates the feasibility of the Myval THV for valve-in-MAC in challenging mitral anatomy.

Keywords: Mitral annular calcification, myval, neo-LVOT, structural heart disease, transcatheter mitral valve replacement