A Step-Wise Approach to Preventing LVOT Obstruction in Patients Undergoing TMVR With High Risk Anatomy and Addressing Valve Popout in TAVR

National Heart Valve Disease Awareness Day
As part of American Heart Month, and in recognition of National Heart Valve Disease Awareness Day on Feb. 22, the ACC Interventional Leadership Council has recorded a series of videos focused on valvular heart disease, including case presentations and highlights from the latest American College of Cardiology and American Heart Association valve disease guidelines. See the entire series on the Invasive CV Angiography and Intervention Clinical Topic Collection. For patient resources, check out CardioSmart's Heart Valve Disease Hub and "Heart Valve Disease Treatment with TAVR" infographic.

Benjamin Galper, MD, MPH, FACC, Director of Structural Heart Disease Program Mid-Atlantic Permanente Medical Group (MAPMG), Assistant Chief of Cardiology at MAPMG Northern Virginia service area, Medical Director of Structural Heart Disease Program at Virginia Hospital Center, shares two cases detailing the intraprocedural steps of a LAMPOON procedure for a transcatheter mitral valve replacement (TMVR) procedure at a high risk of left ventricular outflow tract (LVOT) obstruction and a rescue procedure of a pop out transcatheter aortic valve replacement (TAVR) valve.

Video 1: Averting Disaster During TAVR: A Case of Valve Popout

Video 2: TMVR in a Patient With High Risk of LVOT Obstruction: A Case Presentation


  1. Babaliaros VC, Greenbaum AB, Khan JM, et al. Intentional Percutaneous Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction During Transcatheter Mitral Valve Replacement: First-in-Human Experience. JACC Cardiovasc Interv 2017;10:798-809.
  2. Blanke P, Naoum C, Dvir D, et al. Predicting LVOT Obstruction in Transcatheter Mitral Valve Implantation: Concept of the Neo-LVOT. JACC Cardiovasc Imaging 2017;10:482-5.
  3. Case BC, Lisko JC, Babaliaros VC, et al. LAMPOON techniques to prevent or manage left ventricular outflow tract obstruction in transcatheter mitral valve replacement. Ann Cardiothorac Surg 2021;10:172-9.
  4. Khan JM, Rogers T, Schenke WH, et al. Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow Tract Obstruction During Transcatheter Mitral Valve Replacement: Pre-Clinical Findings. JACC Cardiovasc Interv 2016;9:1835-43.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: Transcatheter Aortic Valve Replacement, Fibrinolytic Agents, Mitral Valve, Tricuspid Valve Insufficiency, American Heart Association, Hospitals, Military, Laboratories, Leadership, Life Expectancy, Aortic Valve Stenosis, Echocardiography, Cardiomyopathy, Hypertrophic, Catheterization, Outcome Assessment, Health Care, Clinical Medicine, Intubation, Intratracheal, Heart Valve Diseases, Coronary Angiography

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