Use of transesophageal echocardiography for transcatheter valve-in-valve implantation for patients with prior bioprosthetic surgical aortic, mitral, tricuspid, and pulmonic valves

Valve-in-valve (ViV) transcatheter procedures are the preferred option for redo valve replacement in patients who otherwise would be high risk for surgery. Transesophageal echocardiography (TEE) is an integral imaging modality for both peri-procedural and intra-procedural guidance during transcatheter ViV replacement. When intentional leaflet laceration is needed, such as with the BASILICA (Bioprosthetic or native Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstructions during TAVR) or LAMPOON (Laceration of the Anterior Mitral valve leaflet to Prevent left ventricular Outlet ObstructioN) procedures, TEE is critical to proper guidewire positioning and achieving a successful laceration. In this paper we detail the role of TEE in ViV transcatheter valve replacement in patients with prior surgical aortic, mitral, tricuspid, and pulmonic valves.