Long or redundant leaflet complicating transcatheter mitral valve replacement

Case vignettes that advocate for removal or reduction of the anterior mitral leaflet

Adam B. Greenbaum, Jose F. Condado, Marvin Eng, Stamatios Lerakis, Dee Dee Wang, Dennis W. Kim, Robert J. Lederman, Gaetano Paone, William W.O. Neill, Vinod H. Thourani, Vasilis C. Babaliaros

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Transcatheter mitral valve replacement (TMVR) procedures can be an alternative to surgical valve replacement for high surgical risk patients with bioprosthetic mitral valves, annuloplasty rings, or severe mitral annular calcification (MAC). TMVR can trigger acute left ventricular outflow tract (LVOT) obstruction from permanent displacement of the native anterior mitral leaflet toward the left ventricular septum, more often among patients undergoing valve-in-ring and valve-in-MAC procedures. Although acute LVOT obstruction is well described in the literature, there are important additional complications of TMVR related to the length and/or redundancy of the anterior mitral valve that have been recognized after mitral valve surgery and have not been previously reported in the setting of TMVR. These additional complications include acute mitral regurgitation secondary to prolapsing native leaflet through the TMVR, frozen TMVR leaflet secondary to overhanging native leaflet and late LVOT obstruction in the neo-LVOT secondary to long native leaflet. Preprocedural planning with imaging (echocardiography and computed tomography) and measurement of anterior mitral leaflet length is critical important in understanding the risk for these complications. As transcatheter mitral valve technology proliferates, interactions with the anterior mitral leaflet after TMVR may be more frequent than initially anticipated. We believe that there is no advantage to an intact anterior leaflet and advocate removal or reduction of the leaflet prior to TMVR.

Original languageEnglish (US)
JournalCatheterization and Cardiovascular Interventions
DOIs
StateAccepted/In press - 2017
Externally publishedYes

Fingerprint

Mitral Valve
Ventricular Outflow Obstruction
Mitral Valve Annuloplasty
Ventricular Septum
Mitral Valve Insufficiency
Surgical Instruments
Echocardiography
Tomography
Technology

Keywords

  • Complications
  • Redundant anterior leaflet
  • Transcatheter mitral valve replacement
  • Valve-in-MAC
  • Valve-in-native
  • Valve-in-ring
  • Valve-in-valve

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Long or redundant leaflet complicating transcatheter mitral valve replacement : Case vignettes that advocate for removal or reduction of the anterior mitral leaflet. / Greenbaum, Adam B.; Condado, Jose F.; Eng, Marvin; Lerakis, Stamatios; Wang, Dee Dee; Kim, Dennis W.; Lederman, Robert J.; Paone, Gaetano; Neill, William W.O.; Thourani, Vinod H.; Babaliaros, Vasilis C.

In: Catheterization and Cardiovascular Interventions, 2017.

Research output: Contribution to journalArticle

Greenbaum, Adam B. ; Condado, Jose F. ; Eng, Marvin ; Lerakis, Stamatios ; Wang, Dee Dee ; Kim, Dennis W. ; Lederman, Robert J. ; Paone, Gaetano ; Neill, William W.O. ; Thourani, Vinod H. ; Babaliaros, Vasilis C. / Long or redundant leaflet complicating transcatheter mitral valve replacement : Case vignettes that advocate for removal or reduction of the anterior mitral leaflet. In: Catheterization and Cardiovascular Interventions. 2017.
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AU - Lerakis, Stamatios

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