{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T12:10:24Z","timestamp":1772021424768,"version":"3.50.1"},"reference-count":8,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and clinical significance. Valve-in-ring (ViR) transcatheter mitral valve replacement (TMVR) is an established therapeutic option for patients with failed surgical mitral valve repair at high surgical risk. Left ventricular outflow tract (LVOT) obstruction and prosthesis-related complications are well described, but other postprocedural findings remain poorly characterized. Case presentation. We report a challenging case of a persistent LVOT mass following ViR TMVR. A 78-year-old man underwent transapical ViR TMVR with a Sapien 3 valve for mitral stenosis. Early post-procedural echocardiography showed normal prosthetic function and no LVOT obstruction. During inpatient cardiac rehabilitation, transthoracic echocardiography revealed a mobile mass in the LVOT. The patient did not show any clinical, microbiological, or laboratory evidence of infection. Blood cultures were negative, and the mass showed no changes despite anticoagulation. Two- and three-dimensional transesophageal echocardiography demonstrated a mobile structure attached to the mitral prosthetic ring by a thin peduncle. After a comprehensive multimodality assessment, thrombus and infective endocarditis were considered unlikely. The mass was ultimately interpreted as a displaced remnant of the native anterior mitral leaflet. Given the prohibitive surgical risk and absence of complications, conservative management with echocardiographic follow-up was adopted. Conclusions. This case study emphasizes the role of advanced echocardiography and multimodality analysis in avoiding misdiagnosis and inappropriate therapeutic interventions.<\/jats:p>","DOI":"10.3390\/jcm15051732","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T10:59:16Z","timestamp":1772017156000},"page":"1732","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unusual Native Valve Remnant in the Left Ventricular Outflow Tract After Valve-in-Ring Transcatheter Mitral Valve Replacement"],"prefix":"10.3390","volume":"15","author":[{"given":"Sergio Enea","family":"Masnaghetti","sequence":"first","affiliation":[{"name":"Laboratory for the Study of Exercise and Cardiorespiratory Signals, Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Veruno Institute, 28013 Gattico-Veruno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabiana Isabella","family":"Gambarin","sequence":"additional","affiliation":[{"name":"Laboratory for the Study of Exercise and Cardiorespiratory Signals, Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Veruno Institute, 28013 Gattico-Veruno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Maff\u00e8","sequence":"additional","affiliation":[{"name":"Division of Cardiology, SS. Trinit\u00e0 Borgomanero Hospital, Azienda Sanitaria Locale Novara, 28021 Borgomanero, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Gnemmi","sequence":"additional","affiliation":[{"name":"Laboratory for the Study of Exercise and Cardiorespiratory Signals, Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Veruno Institute, 28013 Gattico-Veruno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michela","family":"Conti","sequence":"additional","affiliation":[{"name":"Laboratory for the Study of Exercise and Cardiorespiratory Signals, Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Veruno Institute, 28013 Gattico-Veruno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Audo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, Azienda Ospedaliero-Universitaria Santi Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo","family":"Pistono","sequence":"additional","affiliation":[{"name":"Laboratory for the Study of Exercise and Cardiorespiratory Signals, Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Veruno Institute, 28013 Gattico-Veruno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1016\/j.jcin.2021.01.051","article-title":"Prospective Evaluation of TMVR for Failed Surgical Annuloplasty Rings: MITRAL Trial Valve-in-Ring Arm 1-Year Outcomes","volume":"14","author":"Guerrero","year":"2021","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2211","DOI":"10.1016\/j.jcin.2023.06.041","article-title":"5-Year Prospective Evaluation of Mitral Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Outcomes: MITRAL Trial Final Results","volume":"16","author":"Guerrero","year":"2023","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_3","first-page":"627","article-title":"Long or redundant leaflet complicating transcatheter mitral valve replacement: Case vignettes that advocate for removal or reduction of the anterior mitral leaflet","volume":"92","author":"Greenbaum","year":"2018","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1835","DOI":"10.1016\/j.jcin.2016.06.020","article-title":"Intentional laceration of the anterior mitral valve leaflet to prevent left ventricular outflow tract obstruction during transcatheter mitral valve replacement: Pre-clinical findings","volume":"9","author":"Khan","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.jcin.2020.02.006","article-title":"Odd residual regurgitation after mitral valve-in-ring: One you can fix!","volume":"13","author":"Buzzati","year":"2020","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"Rienstra","year":"2024","journal-title":"Eur Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/S0003-4975(96)01107-1","article-title":"Prosthetic mitral valve replacement: Late complications after native valve preservation","volume":"63","author":"Esper","year":"1997","journal-title":"Ann. Thorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1732\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T11:25:43Z","timestamp":1772018743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1732"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":8,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051732"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051732","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]}}}