Severe LVOT Obstruction After Transcatheter Mitral Valve Replacement: Successful Salvage Procedure With a Vascular Stent

Abstract

Objective: We present a successful salvage procedure with vascular stent placement in the left ventricular outflow tract (LVOT) to relieve LVOT obstruction (LVOTO) after transcatheter mitral valve replacement (TMVR).

Key steps: The procedure was performed under general anesthesia, with transesophageal echocardiography and fluoroscopy guidance. Vascular access was obtained via both femoral arteries. Balloon dilatation of the LVOT was performed, after which a 20 × 39 mm stent was deployed.

Potential pitfalls: Potential complications are luxation of the recently implanted TMVR, impairment of TMVR function, septal rupture, and vascular stent entrapment or loss. To improve maneuverability and provide backup, we recommend securing a gooseneck snare to the distal end of the stent.

Take-home messages: LVOTO after TMVR is a feared and potentially fatal complication that may still occur despite thorough preprocedural planning. This complex case demonstrates that LVOTO with hemodynamic compromise after TMVR necessitates timely intervention. With today's advanced interventional techniques, this salvage procedure with vascular stent implantation in the LVOT represents a feasible treatment option.

Keywords: bailout strategy; computed tomography; echocardiography; mitral valve; stents; transcatheter intervention; valve replacement.