Left ventricular outflow tract obstruction due to anterior mitral valve leaflet displacement following transcatheter mitral valve replacement: Considerations for future digital planning

Transcatheter mitral valve replacement (TMVR) is a less invasive alternative for patients with mitral valve disease who are at high surgical risk. TMVR demonstrates favorable outcomes, however left ventricular outflow tract obstruction (LVOTO) remains a notorious, potentially life-threatening complication. Three-dimensional computational models (3DCMs) have been developed to simulate the residual neo-LVOT and assess the risk of LVOTO. However, they do not account for the interaction between the anterior mitral valve leaflet (AMVL) and the transcatheter heart valve. We present the case of an 81-year-old female who had reassuring pre-procedural neo-LVOT assessment but experienced acute LVOTO due to AMVL displacement following TMVR. This case emphasizes the strengths and limitations of current 3DCMs in accurately predicting LVOT obstruction. Furthermore, we discuss techniques to prevent and manage LVOT obstruction after TMVR. • 3D computational modeling tools do not model AMVL–THV interactions after TMVR. • LVOT obstruction can occur despite reassuring pre-procedural neo-LVOT sizing. • Surgical resection of the anterior mitral leaflet is one method to resolve LVOTO.