scholarly journals Intentional Percutaneous Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction During Transcatheter Mitral Valve Replacement

2017 ◽  
Vol 10 (8) ◽  
pp. 798-809 ◽  
Author(s):  
Vasilis C. Babaliaros ◽  
Adam B. Greenbaum ◽  
Jaffar M. Khan ◽  
Toby Rogers ◽  
Dee Dee Wang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Leaflet ◽  
Outflow Obstruction ◽  
Anterior Mitral Leaflet ◽  
Transcatheter Mitral Valve Replacement

Balloon-Augmented Leaflet Modification With Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction and Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction: Benchtop Validation and First In-Man Experience

2021 ◽  
Author(s):  
Emily Perdoncin ◽  
Christopher G. Bruce ◽  
Vasilis C. Babaliaros ◽  
Dursun Korel Yildirim ◽  
Jeremiah P. Depta ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Mitral Leaflet ◽  
Outflow Obstruction ◽  
Anterior Mitral Leaflet ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Mitral Valve Replacement

Background: Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) and laceration of the anterior mitral leaflet to prevent outflow obstruction (LAMPOON) reduce the risk of coronary and left ventricular outflow obstruction obstruction during transcatheter aortic valve replacement and transcatheter mitral valve replacement. Despite successful laceration, BASILICA or LAMPOON may fail to prevent obstruction caused by inadequate leaflet splay in patients having challenging anatomy such as very small valve-to-coronary distance, diffusely calcified, rigid leaflets, or undergoing transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement. We describe a novel technique of balloon-augmented (BA) leaflet laceration to enhance leaflet splay. Methods: We measured the incremental leaflet splay from BA-BASILICA in vitro. From November 2019 to March 2021, 16 patients underwent BA-BASILICA and 4 BA-LAMPOON at 3 centers. Results: BA-BASILICA increased benchtop leaflet tip splay 17%, maximum splay angle 30%, and splay area 23%, resulting in a more rounded apex and larger effective area. Sixteen patients at risk for inadequate BASILICA leaflet splay, including 4 transcatheter aortic valve replacement inside existing transcatheter aortic valve replacement, underwent BA-BASILICA. All had successful leaflet laceration. One had coronary obstruction requiring immediate orthotopic stenting. Two underwent elective orthotopic coronary stenting through the transcatheter valve cells for leaflet prolapse without coronary ischemia. There were no deaths during the procedure or at 30 days. Four patients at risk for inadequate anterior mitral leaflet splay underwent BA-LAMPOON. All had successful target leaflet laceration without left ventricular outflow obstruction obstruction or procedural death. One died within 30 days. Conclusions: BA leaflet laceration enhances leaflet splay in vitro and may allow transcatheter aortic valve replacement and transcatheter mitral valve replacement in patients otherwise ineligible for traditional BASILICA or LAMPOON due to challenging anatomy.

Septal ablation acutely reduces outflow obstruction after transcatheter mitral valve replacement

2019 ◽  
Vol 34 (11) ◽  
pp. 1370-1373
Author(s):  
Aamir Javaid ◽  
Zachary Tyerman ◽  
Jared P. Beller ◽  
Gorav Ailawadi
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Outflow Obstruction ◽  
Transcatheter Mitral Valve Replacement

Posterior mitral leaflet plication for hypertrophic obstructive cardiomyopathy

2018 ◽  
Vol 26 (5) ◽  
pp. 400-403 ◽  
Author(s):  
Praveen Kerala Varma ◽  
Neethu Krishna ◽  
Hisham Ahamed ◽  
Sujatha Madassery
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Systolic Anterior Motion ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Posterior Mitral Leaflet

Anomalies of the mitral valve apparatus in hypertrophic cardiomyopathy are an important cause of systolic anterior motion. Patients with significant residual obstruction due to systolic anterior motion after myectomy and anterior mitral leaflet plication may end up having mitral valve replacement. We describe the case of a 52-year-old man who underwent posterior mitral leaflet plication to correct residual systolic anterior motion after anterior mitral leaflet plication.

scholarly journals IMPACT OF THE PRESERVATION OF THE SUBVALVULAR APPARATUS OF THE ANTERIOR MITRAL LEAFLET ON THE LEFT VENTRICULAR FUNCTION AFTER MITRAL VALVE REPLACEMENT IN EARLY POST-OPERATIVE PERIOD

2020 ◽  
Vol 8 (11) ◽  
pp. 1030-1047
Author(s):  
Mahmoud F. El-Safty ◽  
◽  
Hazem Gamal Bakr ◽  
Mohamed A. El Badawy ◽  
Mohamed Abd El-Hady ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Young Patients ◽  
Left Ventricular ◽  
Valve Disease ◽  
Lv Function ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Group I

Background:Long-term morbidity and mortality appear to be associated with mitral valve replacement for mitral valve disease. The morbidity rate has not decreased dramatically over the years, despite enhancements in myocardial safety and prosthetic valves. Cardiac failure is the most common cause of death following MVR. Subvalvular apparatus preservation preserves LV function and thus improves survival. Repair, particularly with rheumatic valve disease in young patients and extremely disorganised valves, is not always feasible or effective. The use of smaller valve prothesis was not only the argument of preserving the anterior leaflet, but also that it could cause LVOT obstruction. Methods:A prospective controlled randomized study will include(sixty patients aged from 25 to 55 years of both sexes) They will be divided into two groups of patients: Group I: thirty patients who underwent MVR without preservation of The chordae tendinae of the anterior mitral leaflet and only preserving the posterior mitral leaflet. Group II: thirty patients who underwent MVR with complete or partial Preservation of the chordae tendinaeof the anterior mitral leaflet. Results:The sixty patients were divided into two groups where 30 of them underwent preservation of AML, These patients had a better LV function in the early and the short term postoperative period. Conclusion:Results of this study concluded that preservation of the AML leads to better postoperative outcome. We recommend its application on a greater scale of cases of MVR.

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