Tip-to-Base LAMPOON for Transcatheter Mitral Valve Replacement With a Protected Mitral Annulus

Tip-to-base LAMPOON to prevent left ventricular outflow tract obstruction in a valve-in-ring transcatheter mitral valve replacement: First LAMPOON procedure in Turkey and first LAMPOON case for transseptal Myval™ implantation

“…Our case also confirms a universal adaptation of the new technique. However, tip-to-base approach is only applicable in patients with protected annulus with a valve ring or an annuloplasty device (7,8). Moreover, aortic injuries, which require emergent valve replacement, can also develop in some patients.…”

“…The valve deployment was modeled at a 10% to 20% atrial position and at an 80% to 90% ventricular position (Fig. 2b) (8). Predicted neo-LVOT area using virtual 26-mm Myval was calculated and found to be 169 mm 2 (Fig.…”

“…A 6F guiding catheter was inserted through the femoral artery over the wire loop and advanced into the Agilis sheath. The mid segment of a 0.014-inch Astato XS20 wire (Asahi-Intecc, Tokyo, Japan) was kinked and focally denuded outside to form a flying V (5,8,13,14). The Astato guidewire was inserted from the venous side into the Agilis sheath and then advanced into the 6F guiding catheter inside the Agilis sheath and the second venoarterial loop was created (Video 2).…”

“…The denuded and kinked mid segment of the Astato XS20 guidewire (Flying V) was positioned at the anterior leaflet's tip and aligned with the midline of the leaflet and with the aortic root (Fig. 3a) (5,8,13,14). An intraaortic balloon pump (IABP) was placed through a braided 8F Super Arrow-Flex sheath (Teleflex, Morrisville, NC, USA).…”

“…Herein, we present implementation of a newly discovered technique: Tip-to-base LAMPOON procedure before a TMVIR with Myval™ valve (Meril Life Sciences Pvt. Ltd., Vapi, Gujarat, India) (7,8).…”