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Transcatheter aortic valve implantation in a patient with previous Starr-Edwards mitral valve prosthesis
  1. Mohammed Shamim Rahman,
  2. David Roy,
  3. Stephen J Brecker
  1. Department of Cardiology and Cardiothoracic Surgery, St George's Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Mohammed Shamim Rahman, ST5 Cardiology Trainee, Cardiology Department, St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT; shamimrahman{at}

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The first implantation of a Starr-Edwards valve prosthesis was in 1960.1 This valve was extremely successful and many thousands of patients benefited from it. It has been superseded by new valve designs.

A 75-year-old woman with a Starr-Edwards valve in the mitral position inserted in 1996 for mitral stenosis developed symptomatic severe aortic stenosis in 2011. She was considered not suitable for surgical aortic valve replacement due to general frailty and the high risks of a repeat sternotomy and the decision was made for transcatheter aortic valve implantation (TAVI). The patient underwent a transfemoral procedure. During aortic valvuloplasty the balloon was expelled upwards due to impingement on the Starr-Edwards cage (figure 1). A 29 mm Medtronic CoreValve (Minneapolis, Minnesota, USA) was implanted with the base of the frame abutting the Starr-Edwards cage. The procedure was successful and the patient remains well at early follow-up on warfarin.

Figure 1

Fluoroscopic images during the transcatheter aortic valve implantation (TAVI) procedure (A) Angiogram outlining the aortic root, ascending aorta, coronary vessels and Starr-Edwards cage (B) Balloon valvuloplasty with a 22 mm Nucleus balloon as the balloon comes into contact with the cage. The valvuloplasty was repeated with success (C) Initial deployment of the TAVI, seen with an angiogram opacifying the coronary arteries (D) Final position of the TAVI and the Starr-Edwards mitral valve prosthesis.

The protrusion of the Starr-Edwards frame in the left ventricular outflow tract can complicate the implant (figure 2). We successfully implanted a CoreValve TAVI in a patient with a Starr-Edwards mitral valve replacement protruding in the left ventricular outflow tract.

Figure 2

Transthoracic echocardiogram demonstrating the limits of the Starr-Edwards cage and its relation to the left ventricular outflow tract and aortic annulus (A) pre-transcatheter aortic valve implantation (TAVI) and (B) post-TAVI.

The CoreValve was released in 2007, 47 years after the first Starr-Edwards implant and this patient now has one of the oldest and newest valve prostheses.


We would like to thank the patient and the staff of the Department Cardiology and Cardiothoracic Surgery who aided in patient care.


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  • Contributors MSR: prepared manuscript and images. DR: performed the procedure, edited case and images. SJB: in charge of patient care, performed procedure and final edit of manuscript. Responsible for overall manuscript as guarantor.

  • Competing interests SJB is a Proctor for Medtronic CoreValve; DR and MSR have no competing interests to declare.

  • Patient consent Obtained.

  • Ethics approval Informed written consent was obtained from the patient and is submitted with the manuscript.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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