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. Author manuscript; available in PMC: 2017 Jun 20.
Published in final edited form as: JACC Cardiovasc Interv. 2016 Sep 12;9(17):1835–1843. doi: 10.1016/j.jcin.2016.06.020

FIGURE 1. Illustrations of the Technique of Intentional Laceration of the Anterior Mitral Valve Leaflet to Prevent Left Ventricular Outflow Tract Obstruction.

FIGURE 1

(A) Two Judkins left catheters are positioned on either side of the A2 mitral leaflet base. An energized guidewire is advanced from the left ventricular outflow tract (LVOT) catheter into the left atrial catheter snare. (B) The snared tip is externalized to form a guidewire loop around the A2 leaflet. This is energized and pulled outward to lacerate the leaflet lengthwise into 2 halves. (C,E) A transcatheter mitral valve implant tents the anterior mitral leaflet into the septum, obstructing the LVOT. (D,F) Splitting the leaflet by intentional laceration of the anterior mitral valve leaflet to prevent LVOT obstruction instead causes the 2 tethered halves to displace along either side of the transcatheter valve, preventing LVOT obstruction.