Left ventricular outflow tract obstruction after transcatheter mitral valve replacement: the importance of preprocedural planning and prevention

Given the prevalence of mitral valve pathology in high-risk patients, transcatheter mitral valve replacement (TMVR) is becoming an attractive treatment modality. A known complication of TMVR is left ventricular outflow tract obstruction (LVOT) due to the prosthetic mitral valve and native anterior mitral valve leaflet encroaching into the LVOT. This is a serious complication which can lead to decreased cardiac output and death. Preprocedural planning with various imaging modalities (multi-detector cardiac CT and echocardiography) can predict those at high risk of LVOT obstruct. To increase awareness and to prevent this complication from occurring in the future, we present a case of LVOT obstruction after TMVR.