Axiale Turbinenpumpen unterstützen den Kreislauf unabhängig von der Myokardfunktion und dem Rhythmus. Sie können durch eine Einführschleuse rasch mittels Punktion in Seldinger-Technik in den Kreislauf eingebracht und auch leicht wieder explantiert werden. Die Implantationstechnik wird in ihren einzelnen Schritten in diesem Beitrag erläutert.

Interdisciplinary research has become increasingly popular in medical science. It offers a large potential for new perspectives, new inventions, and for researchers more opportunities to publish. Whether all researchers benefit equally from this opportunity when doing interdisciplinary research is unclear. Using data from a survey on German researchers in medical clinics and institutes, we investigate the determinants of research success measured by publication. We control for organizational differences and researchers’ experience level. Running negative binomial regressions, the results suggest that interdisciplinary research is beneficial for researchers on the executive level at institutes with little patient care. On lower hierarchical levels, interdisciplinary research contributes less to publication performance.

Background: Decompressive hemicraniectomy (DHC) after space-occupying strokes among patients older than 60 years has been shown to reduce mortality rates but at the cost of severe disability. There is an ongoing debate about what could be considered an acceptable outcome for these patients. Data about retrospective consent to the procedure after lengthy time periods are lacking. Methods: This study included 79 consecutive patients who underwent DHC during a 7.75-year period. Surviving patients were assessed for functional and psychological outcome, quality of life (QoL) and retrospective consent for the procedure. Patients younger than 60 years were compared with older patients. Results: Of our 79 patients, 44 were younger than 60 years (median 50 years, interquartile range (IQR) 19-59 years) and 35 were older (median 68 years, interquartile range 60-87 years). The 30-day mortality rate was higher for the older group, but the difference was not statistically significant. Functional outcome was significantly better in the younger group: 31% of the patients in this group vs. 10% in the older group had a modified Rankin Scale score of 0-3 (p = 0.046). The mean National Institutes of Health Stroke Scale score was 17 ± 14 for the younger group and 29 ± 15 for the older group (p = 0.002). On the 36-Item Short Form Health Survey, with the exception of the item ‘General health', the older group reported higher values for all items, with statistically significant differences between the 2 groups on the items ‘Role limitation emotional' (p = 0.0007) and ‘Vitality' (p = 0.02). In the younger group, 29% of patients retrospectively declined consent for DHC opposed to 0% of patients in the older group (p = 0.07). Conclusions: Despite impaired functional outcome after DHC, indicators of QoL and retrospective consent are higher for patients older than 60 years over the long term. This finding should be taken into account by those who counsel patients and caregivers with regard to this serious procedure.

Primary objective was to establish the prognostic value of the myocardial load of PVB19 genomes in patients presenting for work-up of myocarditis and/or unclear cardiomyopathy in comparison to clinical, and CMR parameters.

BACKGROUND:The diagnosis of myocarditis is challenging due to its varying clinical presentation. Since myocarditis can be associated with significant 5-year mortality, and postmortem data show myocarditis in almost 10% of all adults suffering sudden cardiac death, individual risk stratification for patients with suspected myocarditis is of great clinical interest. We sought to demonstrate that patients with clinically suspected myocarditis and a normal cardiovascular magnetic resonance (CMR) according to our definition have a good prognosis, independent of their clinical symptoms and other findings.METHODS:Prospective clinical long-term follow-up of consecutive patients undergoing CMR for work-up of clinically suspected myocarditis at our institution in 2007-2008.RESULTS:Follow-up was available for n=405 patients (all-comers, 54.8% inpatients, 38% outpatient referrals from cardiologists). Median follow-up time was 1591 days. CMR diagnosis was "myocarditis" in 28.8%, "normal" in 55.6% and "other pathology" in 15.6%. Normal CMR was defined as normal left ventricular (LV) volumes and normal left ventricular ejection fraction (LV-EF) in the absence of late Gadolinium Enhancement (LGE). The overall mortality was 3.2%. There were seven cardiac deaths during follow-up, in addition one aborted SCD and two patients had appropriate internal cardioverter defibrillator (ICD) shocks - all of these occurred in patients with abnormal CMR. Kaplan-Meier analysis with log-rank test showed significant difference for major adverse cardiac events (cardiac death, sudden cardiac death (SCD), ICD discharge, aborted SCD) between patients with normal and abnormal CMR (p=0.0003).CONCLUSION:In our unselected population of consecutive patients referred for CMR work-up of clinically suspected myocarditis, patients with normal CMR have a good prognosis independent of their clinical symptoms and other findings.

PURPOSE:To assess prevalence and significance of extra cardiac findings (ECF) in clinical routine cardiovascular magnetic resonance (CMR) studies reported by cardiologists alone versus cardiologist and radiologist working together.METHODS:One-thousand-seventy-four consecutive patients presenting at our institution for CMR work-up of multiple cardiovascular disease entities were enrolled retrospectively in two groups (cardiologists reading alone vs. cardiologists and radiologist reading together).RESULTS:In 1,074 routine CMR studies a total of 357 ECF's were identified in 235 patients yielding a prevalence of 21.9 %. Of these 357 ECF's more than one-third were previously known. In the remaining 223 previously unknown findings 118 (52.9 %) were considered as major ECF's (92 patients), and 105 (47.1 %) were considered as minor ECF's (69 patients). Cardiologists reading alone reported 23 previously unknown ECF's in 23 patients, versus 200 previously unknown ECF in 138 patients by cardiologists and radiologists working together, p < 0.0001. Nevertheless, highly significant ECF's with major prognostic implications, such as the initial diagnosis of malignancy in an individual with no history of cancer, are extremely rare (n = 3, 0.3 %). Cardiologists alone, as well as cardiologists and radiologists working together seem to do well with reporting of such extremely important ECF's.CONCLUSIONS:The prevalence of all ECF's was 21.9 %, and 14.9 % of previously unknown ECF's, respectively. However, the prevalence of highly significant ECF's was low. Joint reading with cardiologists and radiologists may increase the number of ECF's detected in CMR studies, but it remains unclear if this could result in an improved long-term outcome of patients undergoing routine CMR.

CMR is a safe procedure, with high image quality, relevant clinical indications, and a strong impact on patient management. Recommendations for training in cardiovascular magnetic resonance encompass three levels: one month for level 1, three months for level 2, and twelve months for professional expertise at level 3. Interdisciplinary approaches and accreditation programs are needed to further optimize training in cardiovascular magnetic resonance.

Background The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting. Furthermore, interim analysis of the specific protocols should underscore the prognostic potential of CMR. Methods Multi-center registry with consecutive enrolment of patients in 57 centers in 15 countries. More than 27000 consecutive patients were enrolled. Results The most important indications were risk stratification in suspected CAD/Ischemia (34.2%), workup of myocarditis/cardiomyopathies (32.2%), as well as assessment of viability (14.6%). Image quality was diagnostic in more than 98% of cases. Severe complications occurred in 0.026%, always associated with stress testing. No patient died during or due to CMR. In 61.8% CMR findings impacted on patient management. Importantly, in nearly 8.7% the final diagnosis based on CMR was different to the diagnosis before CMR, leading to a complete change in management. Interim analysis of suspected CAD and risk stratification in HCM specific protocols revealed a low rate of adverse events for suspected CAD patients with normal stress CMR (1.0% per year), and for HCM patients without LGE (2.7% per year). Conclusion The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM. Condensed abstract The EuroCMR registry sought to evaluate indications, image quality, safety and impact on patient management of clinical routine CMR in a multi-national European setting in a large number of cases (n > 27000). Based on our data CMR is frequently performed in European daily clinical routine. The most important indications in Europe are risk stratification in suspected CAD/Ischemia, work-up of myocarditis and cardiomyopathies, as well as assessment of viability. CMR imaging is a safe procedure, has diagnostic image quality in more than 98% of cases, and its results have strong impact on patient management. Interim analyses of the specific protocols underscore the prognostic value of clinical routine CMR in CAD and HCM.

Myocarditis is an inflammatory condition affecting the myocardium. The presentation and clinical course of myocarditis can be highly variable which makes it difficult to diagnose the disease. EMB can ascertain the diagnosis by (immuno-) histologic methods, PCR may in addition detect the presence of viral genomes which often play a pathogenic role in myocarditis. However, EMB is not often performed.CMR is a non-invasive technique that offers the possibility to analyze left ventricular function with great precision. Myocardial scars or necroses can be visualized by LGE. In myocarditis the typical pattern of LGE is epicardial or intramural. LGE in patients with myocarditis is associated with an unfavourable prognosis and an increased rate of cardiac events. In acute myocarditis T2-weighted images performed before administration of contrast agents may show myocardial oedema.

Die kardiale Magnetresonanztomografie ist ein sicheres bildgebendes Verfahren mit hoher Bildqualität und klinisch bedeutsamen Indikationen und Befunden, die das Patientenmanagement stark beeinflussen. Aktuelle Weiterbildungscurricula enthalten 3 Stufen von Expertise: 1 Monat in der Basisstufe 1 (Kennenlernen von typischen Indikationen und Befunden), 3 Monate in der Stufe 2, die zum eigenverantwortlichen Untersucher, und 12 Monate und mehr als 300 Untersuchungen auf der Stufe 3, die zum Weiterbilder berechtigt. Interdisziplinäre Programme unter Beteiligung von Kardiologen und Radiologen sind geeignet, die Weiterbildung in der kardialen Magnetresonanztomografie weiter zu verbessern.

Die Myokarditis stellt eine entzündliche Erkrankung des Herzmuskels dar, die verschiedenste Verläufe zeigen kann und klinisch oft schwierig zu diagnostizieren ist. Mittels endomyokardialer Biopsie (EMB) lässt sich die Diagnose (immun-)histologisch sichern, in der PCR ist auch der Nachweis von Virusgenomen, die als Auslöser vermutet werden, möglich. Allerdings wird die EMB oft aus verschiedenen Gründen nicht durchgeführt. Die kardiale MRT bietet als nicht invasive Methode zunächst die Möglichkeit, die linksventrikuläre Funktion präzise zu bestimmen. Mittels LGE lassen sich auch Narben oder Nekrosen, vornehmlich als intramurale und epikardiale Kontrastmittelanreicherungen nachweisen. Ein in der MRT nachweisbares LGE ist dabei nachweislich mit einer ungünstigeren Prognose und einer erhöhten Rate kardialer Ereignisse assoziiert. Bei akuten Verlaufsformen kann optional auch mit T2-gewichteten Bildern (vor Gabe von KM) das akute Ödem dargestellt werden.

OBJECTIVES:This study aimed to demonstrate that the presence of late gadolinium enhancement (LGE) is a predictor of death and other adverse events in patients with suspected cardiac sarcoidosis. BACKGROUND:Cardiac sarcoidosis is the most important cause of patient mortality in systemic sarcoidosis, yielding a 5-year mortality rate between 25% and 66% despite immunosuppressive treatment. Other groups have shown that LGE may hold promise in predicting future adverse events in this patient group. METHODS:We included 155 consecutive patients with systemic sarcoidosis who underwent cardiac magnetic resonance (CMR) for workup of suspected cardiac sarcoid involvement. The median follow-up time was 2.6 years. Primary endpoints were death, aborted sudden cardiac death, and appropriate implantable cardioverter-defibrillator (ICD) discharge. Secondary endpoints were ventricular tachycardia (VT) and nonsustained VT. RESULTS:LGE was present in 39 patients (25.5%). The presence of LGE yields a Cox hazard ratio (HR) of 31.6 for death, aborted sudden cardiac death, or appropriate ICD discharge, and of 33.9 for any event. This is superior to functional or clinical parameters such as left ventricular (LV) ejection fraction (EF), LV end-diastolic volume, or presentation as heart failure, yielding HRs between 0.99 (per % increase LVEF) and 1.004 (presentation as heart failure), and between 0.94 and 1.2 for potentially lethal or other adverse events, respectively. Except for 1 patient dying from pulmonary infection, no patient without LGE died or experienced any event during follow-up, even if the LV was enlarged and the LVEF severely impaired. CONCLUSIONS:Among our population of sarcoid patients with nonspecific symptoms, the presence of myocardial scar indicated by LGE was the best independent predictor of potentially lethal events, as well as other adverse events, yielding a Cox HR of 31.6 and of 33.9, respectively. These data support the necessity for future large, longitudinal follow-up studies to definitely establish LGE as an independent predictor of cardiac death in sarcoidosis, as well as to evaluate the incremental prognostic value of additional parameters.

HomeCirculationVol. 125, No. 18Long-Term Impact of Undetected Kawasaki Syndrome on Coronary Morphology and Physiology Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessBrief ReportPDF/EPUBLong-Term Impact of Undetected Kawasaki Syndrome on Coronary Morphology and Physiology Stefan Grün, MD, Maik Backes, MD, Julia Schumm, MD, Simon Greulich, MD, Peter Ong, MD, Angela Geissler, MD, Udo Sechtem, MD and Heiko Mahrholdt, MD Stefan GrünStefan Grün From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Maik BackesMaik Backes From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Julia SchummJulia Schumm From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Simon GreulichSimon Greulich From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Peter OngPeter Ong From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Angela GeisslerAngela Geissler From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. , Udo SechtemUdo Sechtem From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. and Heiko MahrholdtHeiko Mahrholdt From the Departments of Cardiology (S. Grün, J.S., S. Greulich, P.O., U.S., H.M.) and Radiology (M.B., A.G.), Robert Bosch Medical Center, Stuttgart, Germany. Originally published8 May 2012https://doi.org/10.1161/CIRCULATIONAHA.111.076612Circulation. 2012;125:e640–e644A 68-year-old white man presented for work-up of recurring atypical resting chest pain in the setting of known coronary artery disease. ECG and chest x-ray on admission can be viewed in Figures 1 and 2. Two years previously, invasive angiography was performed because of unstable angina revealing dilative coronary sclerosis of all coronaries with a proximal right coronary artery stenosis, which was treated with percutaneous intervention by another cardiologist at that time (Figure 3 and online-only Data Supplement Movies I–III).Download figureDownload PowerPointFigure 1. Twelve-lead ECG on admission demonstrating left-axis deviation, ectopic beats, and nonsignificant ST-segment abnormalities.Download figureDownload PowerPointFigure 2. Chest x-ray on admission revealing a normal-size heart, aspects of pulmonary emphysema, and small amounts of fluid in the right costophrenic angle.Download figureDownload PowerPointFigure 3. First invasive coronary angiography of the left (LCA) (A) and the right (RCA) (B) coronary arteries performed by another cardiologist 2 years previously. Note the proximal RCA stenosis (white arrows) in the setting of diffuse dilative coronary sclerosis (C), which was treated by percutaneous intervention.To evaluate possible progress of coronary artery disease, adenosine stress first-pass perfusion cardiovascular magnetic resonance (CMR) using a 1.5T Magnetom Aera (Siemens Healthcare, Erlangen, Germany) was performed. However, no myocardial ischemia could be detected by CMR in this patient (Figure 4 and online-only Data Supplement Movies IV and V). Late gadolinium enhancement revealed subendocardial infarcts in the inferior and lateral walls (Figure 4).Download figureDownload PowerPointFigure 4. Perfusion CMR results can be viewed in the upper panel. (A, B) Note that no perfusion defect is detectable by visual analysis in this patient. Additional post processing to maximize the display of contrast or quantitative perfusion analysis may be helpful in this setting; however, these techniques are not yet widely available to clinicians. The bottom panel (C, D) shows the results of late gadolinium enhancement in the 4-chamber view (4 CH) and the short axis (SAX). White arrows indicate subendocardial infarct scars in the lateral and inferior walls.In the presence of atypical chest pain and 2 subendocardial infarct scars, we performed additional invasive angiography to rule out a false-negative first-pass perfusion CMR study failing to detect flow inhomogeneity as a result of very diffuse coronary disease. We also performed acetylcholine testing for work-up of possible functional coronary disease. Angiography did not reveal any relevant coronary stenosis but confirmed severe dilative coronary sclerosis (Figure 5), which had also been present and reported 2 years before. In addition, an unclear calcified structure (20×17 mm) in proximity to the right coronary artery was detected for the first time (Figure 5). Acetylcholine testing demonstrated epicardial coronary artery spasm with >75% epicardial narrowing in the left as well as in the right coronary artery (Figure 6, white arrows, and online-only Data Supplement Movies VI–IX). During spasms, the patient reported the same chest pain leading to the actual hospital admission. Chest pain as well as spasms resolved after nitroglycerine, indicating that epicardial coronary spasm was involved in the patient's current complaints.Download figureDownload PowerPointFigure 5. Second invasive coronary angiography of the left (LCA) (A) and the right (RCA) (B) coronary arteries. Note severe dilative coronary sclerosis (white arrows) in the entire system. The right image demonstrates an unclear calcified structure (20×17 mm) in proximity to the right coronary artery (white box) (C).Download figureDownload PowerPointFigure 6. Results of intracoronary acetylcholine testing to identify coronary spasm (A–D). The acetylcholine dose is 80 to 100 μg per vessel (> 200 μg unselective in the left main and 80 μg in the right coronary artery). Note epicardial coronary spasm in the right and the left coronary arteries indicated by white arrows (compare upper to lower panel). ACH indicates acetylcholine.Cardiac computed tomography using a 128-slice dual-source Somatom Definition Flash (Siemens Healthcare, Erlangen, Germany) was also performed for evaluation of the unclear calcified cardiac mass seen during invasive angiography. Computed tomography clearly identified the mass as a giant calcified aneurysm of the proximal right coronary artery (31×19×15 mm) with significant intra-aneurysmal thrombus formation (Figure 7). Additional aneurysms could be identified in the distal right coronary and the circumflex artery, indicating that this patient may have suffered from undetected and untreated Kawasaki syndrome during childhood.Download figureDownload PowerPointFigure 7. A, Volume-rendering technique reconstruction of the myocardial surface in left-posterior projection with view on the ramus circumflexus (CX). The white arrow marks an aneurysm of the CX. B, Curved reconstruction of the CX. C, The primary reconstructed transversal data set (the CX aneurysm is marked with a white square). Most notable (D) is a parietal incomplete thrombosis of the aneurysm. D, Volume-rendering technique reconstructed image in right anterior projection with view of the right coronary artery (RCA). This aneurysm could not be assessed satisfactorily by invasive angiogram because of partial thrombosis within the aneurysm (white arrow). The curved reconstruction of the RCA (E) and the primary reconstructed transversal data set prove that the unclear structure shown in Figure 5c is an almost circularly calcified, partially thrombosed RCA aneurysm.Combining all available evidence in this case, one may conclude that this patient suffered Kawasaki syndrome causing multiple calcified (giant) coronary aneurysms and dilative coronary sclerosis. Intra-aneurysmal thrombus formation and subsequent coronary embolism are the most likely mechanism for the 2 subendocardial infarcts in the circumflex and right coronary artery territory, whereas the actual episodes of atypical resting chest pain leading to the current hospital admission are most likely the result of recurring epicardial coronary vasospasm. With this in mind, it remains unclear why Kawasaki syndrome was not already suspected on the basis of the coronary morphology demonstrated by the first invasive angiography performed 2 years previously. However, this diagnosis was not made at that time.This case is unique in that we do not only visualize the long-term impact of undetected and untreated Kawasaki syndrome on coronary morphology and physiology using a multimodality approach, but also describe coronary vasospasm as a clinically relevant feature in addition to coronary aneurysm formation in this setting for the first time.DisclosuresNone.FootnotesThe online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.111.076612/-/DC1.Correspondence to Heiko Mahrholdt, MD, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany. E-mail Heiko.[email protected]de Previous Back to top Next FiguresReferencesRelatedDetailsCited By Li C, Du Y, Wang H, Wu G and Zhu X (2021) Neonatal Kawasaki disease, Medicine, 10.1097/MD.0000000000024624, 100:7, (e24624) Blaivas M (2020) Unexpected finding of myocardial depression in 2 healthy young patients with COVID‐19 pneumonia: possible support for COVID‐19‐related myocarditis, Journal of the American College of Emergency Physicians Open, 10.1002/emp2.12098, 1:4, (375-378), Online publication date: 1-Aug-2020. Ye Q, Shao W, Shang S, Zhang T, Hu J and Zhang C (2015) A Comprehensive Assessment of the Value of Laboratory Indices in Diagnosing Kawasaki Disease, Arthritis & Rheumatology, 10.1002/art.39112, 67:7, (1943-1950), Online publication date: 1-Jul-2015. May 8, 2012Vol 125, Issue 18 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.111.076612PMID: 22566354 Originally publishedMay 8, 2012 PDF download Advertisement SubjectsComputerized Tomography (CT)Diagnostic TestingImaging

Cardiac magnetic resonance with late gadolinium enhancement (LGE) is a well-established method for in vivo detection of myocardial scarring. Several recent studies have investigated the prognostic value of LGE in patients with hypertrophic cardiomyopathy (HC). We discuss the prevalence and patterns of scarring in HC and its pathophysiologic significance, with focus on ventricular arrhythmias and sudden cardiac death. The available evidence that myocardial scar demonstrated by LGE is a good independent predictor of cardiac mortality in HC is summed up. Recommendations of current guidelines for prevention of sudden cardiac death in HC are discussed with regard to recent results, and the significance of LGE as an emerging risk factor is pointed out. In conclusion, it is demonstrated that LGE has incremental value in addition to clinical risk factors for risk stratification and management of patients with HC.

A 31-year–old white male patient was transferred from a local district hospital for suspected pericardial mass. Two months earlier he had been admitted there for worsening shortness of breath and subsequently was diagnosed with a large pericardial effusion. He had no other pertinent past medical history. After pericardiocentesis (1.5 L) there was no evidence of malignant cells on cytology, and a computed tomography scan did not reveal any abnormality. Thus, the incident was interpreted as (viral) infectious pericarditis and the patient clinically improved under anti-inflammatory medication within 4 weeks. After that, while on a holiday in Tunisia, he again reported worsening shortness of breath. On day 6 of his holiday, he suddenly passed out and was admitted to a local hospital for unexplained syncope, where again a large pericardial effusion was seen. This time, after another pericardiocentesis (1 L), a pericardial mass was suspected …

Exercise electrocardiography (ECG) is frequently used in the work-up of patients with suspected coronary artery disease (CAD), however the accuracy is reduced in women. Cardiovascular magnetic resonance (CMR) stress testing can accurately diagnose CAD in women. To date, a direct comparison of CMR to ECG has not been performed.

Percutaneous aortic valve replacement represents a minimally invasive alternative to open heart valve replacement in high-risk patients. Interventional procedures are used in an increasing number of patients and indications are broadened as techniques further evolve. However, there are still many postulated contraindications for interventional aortic valve replacement. We report a case of successful transfemoral aortic valve replacement in a patient with a mechanical mitral valve, performed due to the patient's refusal to accept blood transfusions. The feasibility and good procedural result may further extend future indications for interventional valve replacement.