Two-in-One Using 3D: Mitral Paravalvular Leak Closure with Concomitant Transcatheter Valve-in-Valve Implantation

An 81-year-old male patient presented with symptoms of increasing fatigue and exertional dyspnea. The patient had a complex cardiac history with multiple admissions for congestive heart failure treatment. In 2007, he underwent combined coronary artery bypass grafting and bioprosthetic aortic (25-mm Hancock II Ultra; Medtronic, Dublin, Ireland) and bioprosthetic mitral (27-mm Carpentier-Edwards; Edwards Lifesciences, Irvine, CA) valve replacements. More recently, he underwent atrioventricular nodal ablation therapy for chronic atrial fibrillation and cardioverter-defibrillator implantation for recurrent ventricular tachycardia.