Background and objectives: Transcatheter aortic valve implantation (TAVI) is a therapeutic choice for high surgical risk patients, serving as an alternative to open-heart surgery. Correct measurement of the aortic annulus, which leads to the selection of a suitable prosthesis and accurate outcome prediction, is essential for the success of TAVI. The objective of this study is to evaluate the accuracy of novel imaging te chniques in measuring the aortic annulus by comparing multi-detector computer tomography (MDCT) and three-dimensional transesophageal echocardiography (3D TEE) for the selection of the optimal prosthesis. Materials and Methods: Measurements of the aortic annulus have been performed on 25 patients using MDCT and TEE, and the correlation and agreement levels between the two measuring techniques were analyzed. MDCT measurements were used for the sizing of the prostheses. Results: MDCT and TEE measurements of aortic annular diameters were significantly correlated, with a mean difference of 0.001 cm. Conclusions: 3D TEE measurements have been in good agreement with MDCT and, therefore, 3D TEE can be used as an alternative in cases where MDCT is contraindicated or not available.

Background: The population of patients surviving previous multivalve surgery is expanding, and structural Heart Teams increasingly encounter complex, multivalvular disease requiring reintervention, for which redo surgery often carries prohibitive risk. Combined, single-session transcatheter treatment of two diseased valves is increasingly reported, but patient selection, procedural sequencing, prosthesis choice, and, in particular, pacing strategy and protection of pre-existing intracardiac hardware remain largely unstandardized. Case Presentation: We report a 73-year-old woman with a twenty-year history of rheumatic multivalvular heart disease, comprising mechanical mitral valve replacement, tricuspid annuloplasty and pacemaker implantation in 2006, redo bioprosthetic tricuspid valve replacement in 2019, and, in 2026, critical native aortic stenosis combined with severe bioprosthetic tricuspid stenosis. After multidisciplinary evaluation, the patient underwent single-stage transfemoral transcatheter aortic valve implantation (TAVI) followed immediately by tricuspid valve-in-valve implantation using a reversed balloon-expandable valve, with dedicated stiff guidewires positioned in each ventricle before device deployment and used as combined delivery-and-pacing platforms. Both procedures were successful, with no lead dysfunction, paravalvular leak, or other complications. Review: Using this case as a clinical anchor, we review contemporary evidence on simultaneous double-valve transcatheter intervention, addressing patient selection, the rationale for simultaneous versus staged treatment, valve sequencing, procedural planning, prosthesis choice, pacing strategies — including guidewire-based and leadless pacing — and management of permanent pacing leads, and propose a practical decision algorithm to guide Heart Team planning in similarly complex patients. Conclusions: Individualized, literature-informed Heart Team planning, including a dedicated biventricular guidewire strategy, can simplify combined transcatheter treatment of multivalvular disease in patients with pre-existing intracardiac hardware; this review provides a structured framework to support such planning as the evidence base for combined double-valve transcatheter intervention continues to grow.

Background/Objectives: Severe mitral regurgitation (MR) is associated with chronic atrial stretch, chamber enlargement, pulmonary pressure elevation, and atrial fibrosis, yet the relationship between tissue inflammatory/profibrotic signaling, histologically quantified fibrosis, and echocardiographic remodeling remains incompletely characterized. This study aimed to compare biatrial tissue remodeling in patients with severe MR undergoing mitral valve surgery with a practical non-valvular surgical comparator group undergoing isolated coronary artery bypass grafting (CABG). Methods: This single-center, observational, cross-sectional comparative study included 36 elective cardiac-surgery patients: 22 with severe MR and 14 undergoing isolated CABG without significant valvular disease. Left- and right-atrial tissue samples were collected intraoperatively. IL-6, TNF-α, and TGF-β expression was assessed by quantitative real-time PCR using pooled atrial samples stratified by atrial side and study group, whereas atrial fibrosis was quantified histologically on individual tissue specimens using Masson’s trichrome staining and digital image analysis. Clinical, laboratory, and echocardiographic parameters were compared between groups, and exploratory associations were assessed with cautious interpretation. Results: Compared with the CABG comparator group, patients with severe MR showed a pooled molecular profile compatible with higher aggregate atrial expression of IL-6, TNF-α, and TGF-β; because qPCR was performed on pooled tissue preparations, these molecular findings were interpreted descriptively and were not used for patient-level inferential statistics. Histologically quantified fibrosis was significantly increased in severe MR in both the left atrium (29.69 ± 12.26% vs. 12.17 ± 4.56%, p < 0.0001) and the right atrium (25.25 ± 11.33% vs. 9.01 ± 4.46%, p < 0.0001). The MR group also showed more pronounced echocardiographic remodeling, including larger estimated left atrial volume, higher pulmonary artery systolic pressure, and greater right ventricular diameter. Exploratory individual-level analyses were restricted to histological fibrosis and echocardiographic variables. Conclusions: Severe MR was associated with marked echocardiographic remodeling and significantly greater histologically quantified biatrial fibrosis compared with a CABG surgical comparator group. Pooled qPCR findings support an aggregate inflammatory/profibrotic signal, but they should be interpreted descriptively because individual-level molecular variability could not be assessed. These findings are hypothesis-generating and do not establish causality.

Background: The population of patients surviving previous multivalve surgery is expanding, and structural Heart Teams increasingly encounter complex multivalvular disease requiring reintervention, for which redo surgery carries prohibitive risk. Patient selection, sequential procedural planning, prosthesis choice, and, in particular, pacing strategy and protection of pre-existing intracardiac hardware remain unstandardized. Case Presentation: We report a 73-year-old woman with a twenty-year history of rheumatic multivalvular heart disease, comprising mechanical mitral valve replacement, tricuspid annuloplasty and pacemaker implantation, redo bioprosthetic tricuspid valve replacement, and critical native aortic stenosis combined with severe bioprosthetic tricuspid regurgitation. After multidisciplinary Heart Team evaluation, the patient underwent successful single-session, sequential transfemoral transcatheter aortic valve implantation followed immediately by tricuspid valve-in-valve implantation using a reversed balloon-expandable valve and a dedicated biventricular guidewire pacing strategy. The sequential interventions achieved immediate hemodynamic success with no lead dysfunction, paravalvular leak, or other acute complications. Review: Using this case as a clinical anchor, we present a focused, case-based review of contemporary evidence on single-session double-valve transcatheter intervention. We address patient selection, procedural sequencing, imaging, prosthesis choice, and management of chronic transvenous pacing leads, providing a practical decision-making algorithm to guide Heart Teams in similarly complex scenarios. Conclusions: Individualized, multidisciplinary Heart Team planning, including a dedicated biventricular guidewire strategy, can simplify sequential transcatheter treatment of multivalvular disease in patients with pre-existing intracardiac hardware. This case-based review provides a pragmatic, hypothesis-generating framework to support clinical decision-making as the body of evidence for combined double-valve transcatheter interventions continues to evolve.