Table 1
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Timeline of events

July 2020Single-chamber VVI pacemaker implantation for permanent atrial fibrillation with symptomatic bradycardias (syncope).
December 2022The patient underwent indirect mitral annuloplasty using the Carillon 12/18/80 mm Mitral Contour System (Cardiac Dimensions, Kirkland, WA) for severe mitral regurgitation (MR) mixed-genesis (effective regurgitant orifice area, 0.53 cm2; regurgitant volume, 89 mL).
February 2023The patient complained of recurrent retrosternal pain. The coronary angiography revealed a severe coronary artery disease. A drug-eluting stent was implanted for the left anterior coronary artery after intracoronary lithoplasty and a dual anti-platelet therapy was started.
May 2023The patient was referred to our hospital for acute heart failure, New York Heart Association (NYHA) IV. Transthoracic echocardiography (TTE) showed LVEF 65% and severe MR (vena contracta, 0.8 cm; EROA, 0.36 cm2; R-Vol 55 mL) with pulmonary hypertension (right ventricular systolic pressure 91 mmHg).
July 2023After multidisciplinary cardiac team discussions, the patient underwent off-label dedicated beating heart transapical tether-based standard profile (SP) 33M Tendyne TMVR system (Abbot Structural Heart) and a scissor-mediated splitting of the anterior mitral valve leaflet (AML) (MitraCut technique) due to anticipated risk for left ventricular outflow tract obstruction (LVOT-O) with a cross-sectional neo-LVOT area (399.6 mm2 in end-systole) and an elongated AML (27 mm).
Days 1–2The patient was transferred to the ICU after the procedure. The post-operative TTE showed a well-functioning transcatheter heart valve without paravalvular leak and thrombus or LVOT-O.
July 2020Single-chamber VVI pacemaker implantation for permanent atrial fibrillation with symptomatic bradycardias (syncope).
December 2022The patient underwent indirect mitral annuloplasty using the Carillon 12/18/80 mm Mitral Contour System (Cardiac Dimensions, Kirkland, WA) for severe mitral regurgitation (MR) mixed-genesis (effective regurgitant orifice area, 0.53 cm2; regurgitant volume, 89 mL).
February 2023The patient complained of recurrent retrosternal pain. The coronary angiography revealed a severe coronary artery disease. A drug-eluting stent was implanted for the left anterior coronary artery after intracoronary lithoplasty and a dual anti-platelet therapy was started.
May 2023The patient was referred to our hospital for acute heart failure, New York Heart Association (NYHA) IV. Transthoracic echocardiography (TTE) showed LVEF 65% and severe MR (vena contracta, 0.8 cm; EROA, 0.36 cm2; R-Vol 55 mL) with pulmonary hypertension (right ventricular systolic pressure 91 mmHg).
July 2023After multidisciplinary cardiac team discussions, the patient underwent off-label dedicated beating heart transapical tether-based standard profile (SP) 33M Tendyne TMVR system (Abbot Structural Heart) and a scissor-mediated splitting of the anterior mitral valve leaflet (AML) (MitraCut technique) due to anticipated risk for left ventricular outflow tract obstruction (LVOT-O) with a cross-sectional neo-LVOT area (399.6 mm2 in end-systole) and an elongated AML (27 mm).
Days 1–2The patient was transferred to the ICU after the procedure. The post-operative TTE showed a well-functioning transcatheter heart valve without paravalvular leak and thrombus or LVOT-O.
Table 1
Open in new tab

Timeline of events

July 2020Single-chamber VVI pacemaker implantation for permanent atrial fibrillation with symptomatic bradycardias (syncope).
December 2022The patient underwent indirect mitral annuloplasty using the Carillon 12/18/80 mm Mitral Contour System (Cardiac Dimensions, Kirkland, WA) for severe mitral regurgitation (MR) mixed-genesis (effective regurgitant orifice area, 0.53 cm2; regurgitant volume, 89 mL).
February 2023The patient complained of recurrent retrosternal pain. The coronary angiography revealed a severe coronary artery disease. A drug-eluting stent was implanted for the left anterior coronary artery after intracoronary lithoplasty and a dual anti-platelet therapy was started.
May 2023The patient was referred to our hospital for acute heart failure, New York Heart Association (NYHA) IV. Transthoracic echocardiography (TTE) showed LVEF 65% and severe MR (vena contracta, 0.8 cm; EROA, 0.36 cm2; R-Vol 55 mL) with pulmonary hypertension (right ventricular systolic pressure 91 mmHg).
July 2023After multidisciplinary cardiac team discussions, the patient underwent off-label dedicated beating heart transapical tether-based standard profile (SP) 33M Tendyne TMVR system (Abbot Structural Heart) and a scissor-mediated splitting of the anterior mitral valve leaflet (AML) (MitraCut technique) due to anticipated risk for left ventricular outflow tract obstruction (LVOT-O) with a cross-sectional neo-LVOT area (399.6 mm2 in end-systole) and an elongated AML (27 mm).
Days 1–2The patient was transferred to the ICU after the procedure. The post-operative TTE showed a well-functioning transcatheter heart valve without paravalvular leak and thrombus or LVOT-O.
July 2020Single-chamber VVI pacemaker implantation for permanent atrial fibrillation with symptomatic bradycardias (syncope).
December 2022The patient underwent indirect mitral annuloplasty using the Carillon 12/18/80 mm Mitral Contour System (Cardiac Dimensions, Kirkland, WA) for severe mitral regurgitation (MR) mixed-genesis (effective regurgitant orifice area, 0.53 cm2; regurgitant volume, 89 mL).
February 2023The patient complained of recurrent retrosternal pain. The coronary angiography revealed a severe coronary artery disease. A drug-eluting stent was implanted for the left anterior coronary artery after intracoronary lithoplasty and a dual anti-platelet therapy was started.
May 2023The patient was referred to our hospital for acute heart failure, New York Heart Association (NYHA) IV. Transthoracic echocardiography (TTE) showed LVEF 65% and severe MR (vena contracta, 0.8 cm; EROA, 0.36 cm2; R-Vol 55 mL) with pulmonary hypertension (right ventricular systolic pressure 91 mmHg).
July 2023After multidisciplinary cardiac team discussions, the patient underwent off-label dedicated beating heart transapical tether-based standard profile (SP) 33M Tendyne TMVR system (Abbot Structural Heart) and a scissor-mediated splitting of the anterior mitral valve leaflet (AML) (MitraCut technique) due to anticipated risk for left ventricular outflow tract obstruction (LVOT-O) with a cross-sectional neo-LVOT area (399.6 mm2 in end-systole) and an elongated AML (27 mm).
Days 1–2The patient was transferred to the ICU after the procedure. The post-operative TTE showed a well-functioning transcatheter heart valve without paravalvular leak and thrombus or LVOT-O.
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