Key result
Snare-assisted recrossing enables deeper mitral valve-in-valve-in-ring implantation, resolving regurgitation without LVOT obstruction.
Why the study?
Native mitral leaflet interference is a rare cause of acute intraprosthetic regurgitation after transcatheter mitral valve-in-ring replacement and requires recognition and management strategies.
Does snare-assisted recrossing and deeper valve-in-valve-in-ring implantation resolve acute intraprosthetic regurgitation caused by native leaflet interference during TMViR?
Case Report (n=1)
Does snare-assisted recrossing and deeper valve-in-valve-in-ring implantation resolve acute intraprosthetic regurgitation caused by native leaflet interference during TMViR?
Snare-assisted recrossing provides an effective bailout strategy for acute intraprosthetic regurgitation caused by native leaflet interference during transcatheter mitral valve-in-ring procedures.
Native leaflet interference risks severe regurgitation after mitral valve-in-ring; case report leaves open generalizability of snare-assisted recrossing.
BACKGROUND: Native mitral leaflet interference is a rare cause of acute intraprosthetic regurgitation after transcatheter mitral valve-in-ring replacement (TMViR). CASE SUMMARY: An 83-year-old woman with previous surgical mitral annuloplasty underwent transseptal TMViR for severe regurgitation from anterior mitral leaflet flail. After implantation of a 32-mm Myval Octapro valve, severe intraprosthetic regurgitation developed. High atrial positioning and prosthesis tilting allowed the flail anterior leaflet to overhang the ventricular valve edge and impair prosthetic leaflet coaptation. Balloon postdilation failed and increased instability. A contralateral gooseneck snare enabled controlled recrossing and deeper valve-in-valve-in-ring implantation, with complete regurgitation resolution and no left ventricular outflow tract obstruction. DISCUSSION: Native leaflet interference should be considered after TMViR when acute intraprosthetic regurgitation occurs. TAKE-HOME MESSAGE: Snare-assisted recrossing may provide selective bailout when marked tilt or instability prevents safe conventional recrossing.
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Mangiameli et al. (2026) conducted a case report in Severe mitral regurgitation from anterior mitral leaflet flail after previous surgical mitral annuloplasty (n=1). Snare-assisted recrossing and deeper valve-in-valve-in-ring implantation was evaluated.
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