Key result
TMVR with LAMPOON reduces trans-mitral gradient to ~4 mmHg in severe mitral annular calcification.
Why the study?
The anaesthetic management of TMVR remains underrepresented in the anaesthesia literature, despite procedural risks during LAMPOON and TMVR such as sudden mitral regurgitation, transient hypotension, arrhythmias, and transient LV dysfunction.
Case Report (n=1)
No
This case report highlights the critical anaesthetic considerations, including preparedness for acute severe mitral regurgitation, severe hypotension, and malignant arrhythmias, required to achieve successful outcomes in high-risk patients undergoing TMVR with the LAMPOON procedure for severe mitral annular calcification.
Answers are grounded in this paper and cite their sources.
Supports LAMPOON-TMVR feasibility in severe MAC; leaves open validation of safety and outcomes in prospective studies.
Transcatheter mitral valve replacement (TMVR) is an emerging treatment for patients with mitral valve disease which includes mitral annular calcification who are deemed high-risk for surgical intervention. However, left ventricular outflow tract (LVOT) obstruction remains a significant complication. The Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON) procedure has been developed to mitigate this risk by preemptively splitting the anterior mitral leaflet (AML) before TMVR. The anaesthetic anagement of TMVR remains underrepresented in the anaesthesia literature. Consideration of the procedural approaches, underlying patient pathophysiology, and potential complications allows for the construction of a plan for perioperative management. During lampoon procedure AML laceration causes sudden mitral regurgitation and may cause transient hypotension, wire manipulation increases the risk of arrhythmias and Ballon Inflation & Leaflet Traversal may cause possible transient LV dysfunction. Here, we present the case of a 75-year-old female with severe mitral annular calcification and moderate mitral stenosis with regurgitation, along with severe LV dysfunction. She underwent a successful transcatheter mitral valve replacement (TMVR) with a LAMPOON procedure.
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Kothari et al. (2026) conducted a case report in Severe mitral annular calcification and moderate mitral stenosis with regurgitation (n=1). Transcatheter mitral valve replacement (TMVR) with 26 mm Edwards SAPIEN 3 valve and antegrade LAMPOON procedure was evaluated on Procedural success and post-deployment trans-mitral valve pressure gradient. Transcatheter mitral valve replacement with the LAMPOON procedure in a 75-year-old female with severe mitral annular calcification reduced the trans-mitral gradient from 35/13 mmHg to 6.5/3.5 mmHg.
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