Preprocedural imaging for transcatheter mitral valve-in-valve replacement: Planning makes perfect.

Transcatheter mitral valve-in-valve replacement (TMViVR) in degenerated bioprostheses or valvular rings shows promise as an alternative to surgical MVR in selected high-risk patients. However, these procedures are particularly challenging given the complex anatomy of the mitral valve apparatus and the surrounding structures, potentially causing LV outflow tract obstruction (LVOTO). Preprocedural planning with virtual implantation and planimetric estimation of the neo-LVOT at end-systole is crucial for improving procedural results. In this case, we also include a dynamic evaluation of the neo-LVOT and implement virtual reality imaging for immersive assessment of the implanted valve.