Dynamic Transmitral Gradient From Eccentric Aortic Regurgitation Resolved by Valve-in-Valve TAVR.

Authors

Ishita Ray, Sami Shoura, Ragavendar Saravanabavanandan, Kyle Coombes, Rajvardhan Sisodia, Michael Z Grzeskowiak, Sudhir Mungee, Marco A Barzallo

Published in

JACC. Case reports. Pages 110868. Nov 06, 2026. Epub Nov 06, 2026.

Abstract

Bioprosthetic aortic valve degeneration can present as isolated regurgitant failure, and an eccentric jet may raise the transmitral gradient, mimicking mitral stenosis.
An 84-year-old man presented with acute heart failure 12 years after surgical aortic valve replacement. Echocardiography showed a degenerated Trifecta bioprosthesis with an immobile leaflet causing severe eccentric aortic regurgitation, whose jet impinged on the anterior mitral leaflet and produced severe functional mitral stenosis. Given high surgical risk, the heart team performed transfemoral valve-in-valve transcatheter aortic valve replacement.
Trifecta leaflet tear causes regurgitant rather than stenotic failure; an eccentric jet can raise the transmitral gradient independent of the Austin Flint murmur. Valve-in-valve transcatheter aortic valve replacement eliminated the regurgitation, improved leaflet mobility, and reduced the mean mitral gradient from 17 to 6 mm Hg, with complete symptom resolution.
Eccentric aortic regurgitation can cause a reversible rise in transmitral gradient; treating it can resolve apparent mitral stenosis without mitral intervention.

PMID:
42993128
Bibliographic data and abstract were imported from PubMed on 06 Nov 2026.

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