Native Leaflet Interference After Transcatheter Mitral Valve-in-Ring: Snare-Assisted Valve-in-Valve-in-Ring Bailout.

Q4 Medicine

JACC. Case reports Pub Date : 2026-10-16 DOI:10.1016/j.jaccas.2026.110737

Andrea Mangiameli, Valentina Bernardini, Alessia Azzano, Eligio Miccichè, Davide Cao, Andrea Cascella, Elvis Brscic

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Abstract

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.

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经导管二尖瓣环内置换术后的原生小叶干扰：陷阱辅助环内置换术。

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