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Transcatheter mitral valve implantation (TMVI) is used for treating severe mitral valve regurgitation in patients deemed unsuitable for open-heart surgery.However, delays between preoperative workup and therapy can lead to changes in the clinical condition and structural valve findings, necessitating a meticulous reevaluation of diagnostic and therapeutic options.Case Presentation: A 77-year-old woman with severe mitral valve regurgitation and severe comorbidities was referred to our Heart Team and was deemed suitable for TMVI based on the initial evaluation.The echocardiographic finding showed a severe degenerative mitral valve regurgitation with prolapse of the A3 and P3 segments and an eccentric jet directed posteriorly to the atrial roof but without the complete picture of Barlow's disease.Due to delayed approval by the patient, the therapeutic procedure was postponed.Subsequent echocardiographic reevaluation six months later revealed a hypermobile anterior mitral leaflet resulting from chordal elongation in conjunction with a septal bulge, raising the risk for postoperative left ventricular outflow tract (LVOT) obstruction.To mitigate this risk, TMVI combined with the Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction (LAMPOON) was performed.Postimplantation echocardiography revealed a well-functioning mitral valve prosthesis without para-and transvalvular leak, a mean gradient of 3 mm Hg, and no LVOT obstruction. Conclusion:The diagnostic and therapeutic evaluation of TMVI remains intricate and time-consuming, necessitating thorough planning.Prompt performance of the procedure is crucial to prevent unforeseen structural changes that could jeopardize the patient's outcome.The combination of TMVI with the LAMPOON technique for preventing LVOT obstruction appears feasible and suitable for selected patients.
Vasiloi et al. (Wed,) studied this question.