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Author Notes:

Correspondence to: Vasilis Babaliaros, MD, Emory University Hospital F606, 1364 Clifton Road, Atlanta, GA 30322. vbabali@emory.edu.

Adam Greenbaum is a proctor for Edwards Lifesciences and Abiomed.

Stamatios Lerakis is a consultant for Abbott Vascular.

Gaetano Paone is a proctor for Edwards Lifesciences.

Vinod Thourani is a consultant for Edwards Lifesciences, Maquet, St Jude Medical, and Sorin. He is also co-founder and stock holder of Apica.

Vasilis Babaliaros MD, FACC is a consultant for Abbott Vascular and Edwards Lifesciences.

The other authors have nothing to disclose.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Cardiovascular System & Cardiology
  • transcatheter mitral valve replacement
  • valve-in-valve
  • valve-in-ring
  • valve-in-native
  • valve-in-MAC
  • redundant anterior leaflet
  • complications

Long or Redundant Leaflet Complicating Transcatheter Mitral Valve Replacement: Case Vignettes That Advocate for Removal or Reduction of the Anterior Mitral Leaflet

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Journal Title:

Catheterization and Cardiovascular Interventions


Volume 92, Number 3


, Pages 627-632

Type of Work:

Article | Post-print: After Peer Review


Transcatheter mitral valve replacement (TMVR) procedures can be an alternative to surgical valve replacement for high surgical risk patients with bioprosthetic mitral valves, annuloplasty rings, or severe mitral annular calcification (MAC). TMVR can trigger acute left ventricular outflow tract (LVOT) obstruction from permanent displacement of the native anterior mitral leaflet toward the left ventricular septum, more often among patients undergoing valve-in-ring and valve-in-MAC procedures. Although acute LVOT obstruction is well described in the literature, there are important additional complications of TMVR related to the length and/or redundancy of the anterior mitral valve that have been recognized after mitral valve surgery and have not been previously reported in the setting of TMVR. These additional complications include acute mitral regurgitation secondary to prolapsing native leaflet through the TMVR, frozen TMVR leaflet secondary to overhanging native leaflet and late LVOT obstruction in the neo-LVOT secondary to long native leaflet. Preprocedural planning with imaging (echocardiography and computed tomography) and measurement of anterior mitral leaflet length is critical important in understanding the risk for these complications. As transcatheter mitral valve technology proliferates, interactions with the anterior mitral leaflet after TMVR may be more frequent than initially anticipated. We believe that there is no advantage to an intact anterior leaflet and advocate removal or reduction of the leaflet prior to TMVR. © 2017 Wiley Periodicals, Inc.

Copyright information:

© 2017 Wiley Periodicals, Inc.

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