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. Author manuscript; available in PMC: 2020 Jul 8.
Published in final edited form as: JACC Cardiovasc Interv. 2019 Feb 13;12(13):1283–1284. doi: 10.1016/j.jcin.2018.12.026

Figure: The “rescue” LAMPOON procedure.

Figure:

[A] Cardiac-gated CT shows SAM after TMVR. [B] Illustration of concept: a kinked guidewire lacerates the AML in the direction of the black arrow. [C] Fluoroscopy in RAO with kinked mid-shaft of the Astato guidewire (black arrow) sheathed in two microcatheters (black arrow heads) guided by a transseptal sheath and transfemoral catheter. [D] The guidewire is electrified and pulled to lacerate the native AML. [E] Mid-gastric transesophageal view confirming a split AML parted away from the LVOT. [F-G] Severe LVOT gradient is treated.