Transcatheter Mitral Valve Implantation With the FORTIS Device: Insights Into the Evaluation of Device Success.

A 66-year old man with severe functional mitral regurgitation (Figure 1A) secondary to chronic ischemic cardiomyopathy (previous myocardial infarction and coronary artery bypass grafting) and advanced heart failure (left ventricular ejection fraction: 25%; New York Heart Association [NYHA] functional class III) was considered to be at very high surgical risk and was finally accepted by the Heart Team for transcatheter mitral valve implantation (TMVI) with the FORTIS transcatheter valve (Edwards Lifesciences, Irvine, California) (Figures 1B and 1C). The procedure was performed using previously described techniques (1). In brief, the valve was inserted in the left ventricular cavity using a 40French delivery catheter through the left ventricular apex. The valve prosthesis paddles were unsheathed to capture the native mitral leaflets at the A2-P2 level (Online Video 1). After confirmation of native mitral leaflet capture, full deployment of the valve system was successfully performed (Figure 1D, Online Video 2). After valve deployment, transesophageal echocardiography (TEE) images revealed the presence of a mild to moderate perivalvular leak at the level of the posteromedial commissure (Figure 1E, Online Video 3; Figure 1F, Online Video 4). However, cardiac magnetic resonance (CMR) showed the absence of any residual leak (Figure 1G, Online Video 5), and multislice computed tomography demonstrated the correct