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Updated: Aug 6, 2026

A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
Balloon-Assisted Anterior Mitral Leaflet Translocation for Valve-in-MAC Transcatheter Mitral Valve Replacement
Arturo Giacaman1, Sant Kumar1, Pedro Engel1
1Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA.
Background:
Severe mitral annular calcification (MAC) complicates transcatheter mitral valve replacement (TMVR) by increasing left ventricular outflow tract (LVOT) obstruction risk. Balloon-assisted translocation of the anterior mitral leaflet (BATMAN) may reduce this risk, but experience with native valve-in-mitral annular calcification (ViMAC) remains limited.
Case Summary:
Eleven high-risk patients with symptomatic severe native mitral annular calcification (81.8% NYHA functional class III/IV; predicted neo-LVOT 196.3 ± 88.8 mm2) underwent BATMAN-facilitated ViMAC TMVR. Technical success was 100%, with no valve embolization or significant LVOT obstruction; paravalvular leak closure was required in 27.3%. Predischarge transmitral gradient was 5.4 ± 1.7 mm Hg; 30-day all-cause and cardiac mortality rates were 36.4% and 18.2%, respectively.
Discussion:
Published BATMAN reports support feasibility, but ViMAC-specific data are limited. This series addresses high-risk anatomy with few alternatives and substantial early hazard.
Take-Home Messages:
BATMAN-facilitated ViMAC TMVR appears feasible without technique-related adverse events, but early mortality remains substantial. Use requires multidisciplinary selection and shared decision-making.
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