Transcatheter Mitral Valve Replacement in an Incomplete Ring With LAMPOON Facilitated By Aortic Prosthesis

BACKGROUND: Transcatheter mitral valve replacement in large incomplete flexible mitral bands is high risk because limited anchoring and anterior leaflet displacement may cause embolization or left ventricular outflow tract (LVOT) obstruction. CASE SUMMARY: for a 29-mm balloon-expandable valve. He underwent antegrade base-to-tip laceration of the anterior mitral leaflet to prevent outflow obstruction, followed by valve-in-ring transcatheter mitral valve replacement, with no paravalvular leak or significant LVOT gradient. DISCUSSION: Anterior aortic prosthetic anatomy facilitated valve anchoring despite the incomplete flexible band, which would have been prohibitive in the absence of anterior bioprosthesis. TAKE-HOME MESSAGE: Adjacent prosthetic anatomy may be leveraged in selected complex valve-in-ring procedures after meticulous multimodality planning and procedural expertise.