# Endovascular repair of iliac vein perforation during trans-septal mitral valve-in-valve replacement: a case report

## TL;DR

A rare case of venous perforation during a minimally invasive heart valve replacement procedure was successfully treated with emergency stent placement.

## Contribution

This case report highlights a rare but life-threatening complication of trans-septal mitral valve-in-valve replacement and its successful endovascular management.

## Key findings

- Venous perforation during TMViV can lead to hemorrhagic shock.
- Endovascular repair with covered stents is an effective emergency treatment.
- Venous calcification may increase the risk of such complications.

## Abstract

Transcatheter mitral valve-in-valve (TMViV) replacement via trans-septal access is a less invasive alternative for high-risk patients with degenerated bioprosthetic valves. However, life-threatening venous injuries may occur, though they are rarely reported.

A 73-year-old man with a prior mitral bioprosthetic valve replacement presented with heart failure due to severe prosthetic stenosis. TMViV was planned via a trans-septal approach. During device advancement through the right iliac vein, a massive venous perforation occurred, resulting in haemorrhagic shock. The cause was likely unrecognized venous calcification. Emergent endovascular repair with covered stents successfully stabilized the patient.

This case highlights the risk of catastrophic venous complications during trans-septal TMViV procedures, particularly in patients with venous calcification. Prompt recognition and endovascular intervention can be life-saving in such rare but critical scenarios.