Tip-to-Base LAMPOON to Prevent Left Ventricular Outflow Tract Obstruction in Valve-in-Valve Transcatheter Mitral Valve Replacement

• Authors: Brian C. Case, MedStar Washington Hospital Center; Jaffar M. Khan, MedStar Washington Hospital Center; Lowell F. Satler, MedStar Washington Hospital Center; Itsik Ben-Dor, MedStar Washington Hospital Center; Robert Lederman, Emory University; Vasilis Babaliaros, Emory University; Adam Greenbaum, Emory University; Ron Waksman, MedStar Washington Hospital Center; Toby Rogers, MedStar Washington Hospital Center
• Journal Title: JACC-CARDIOVASCULAR INTERVENTIONS
• Volume: Volume 13, Number 9
• Publisher: ELSEVIER SCIENCE INC | 2020-05-11, Pages 1126-1128
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jcin.2020.01.235
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; LAMPOON; left ventricular outflow tract obstruction; transcatheter electrosurgery; transcatheter mitral valve replacement; valve-in-valve

Abstract

An 84-year-old woman with a history of a 29-mm bioprosthetic Mosaic (Medtronic, Minneapolis, Minnesota) mitral valve replacement presented with heart failure. Transesophageal echocardiography (TEE) demonstrated severe regurgitation (Figure 1A) from torn prosthetic leaflets (Figure 1B). Computed tomography revealed bioprosthetic leaflet near the septum in systole (Figure 1C). Predicted neo-left ventricular outflow tract (LVOT) using virtual 26-mm Sapien S3 (Edwards Lifesciences, Irvine, California) was 177.5 mm2 (Figure 1D). We performed a modification of laceration of the anterior mitral leaflet to prevent LVOT obstruction (LAMPOON) to achieve tip-to-base laceration of the bioprosthetic to prevent LVOT obstruction from valve-in-valve (ViV) transcatheter mitral valve replacement (TMVR).