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Войти в исследования JACC. Case reports · 2026
Native Leaflet Interference After Transcatheter Mitral Valve-in-Ring: Snare-Assisted Valve-in-Valve-in-Ring Bailout.
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Mangiameli Andrea, Bernardini Valentina, Azzano Alessia, Miccichè Eligio, Cao Davide, Cascella Andrea, Brscic Elvis
Аннотация
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.
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.