Surgical bioprosthetic valve in the mitral position typically degenerates in 10-15 years, when intervention is required again. In the past, redo surgical mitral valve replacement has been the only treatment choice for such patients suffering from bioprosthetic valve failure, despite the even higher risk associated with redo open-heart surgery. In recent years, transcatheter valve-in-valve implantation in the mitral position has evolved as an reasonable alternative to redo surgery for the treatment of surgical mitral bioprosthetic valve failure. Here we report an 81-year-old female patient with surgical mitral bioprosthetic valve failure, who successfully underwent valve-in-valve transcatheter mitral valve replacement via the transfemoral-transseptal approach. The procedure was successful owing to comprehensive CT imaging work-up, despite the technical challenges associated with bilateral giant atria and small left ventricle.
