Abstract
BACKGROUND: Transcatheter mitral valve replacement (TMVR) is increasingly recognized as a viable therapeutic modality for complex mitral valve pathology, particularly in patients with intricate anatomical substrates. CASE SUMMARY: We present a 71-year-old woman with recurrent heart failure and severe mixed functional mitral regurgitation and a small neo-left ventricular outflow tract, at risk of left ventricular outflow tract obstruction. Given her surgical risk and complex anatomy, we chose TMVR with the Peijia HighLife Clarity valve, which features an "open-window" design to reduce left ventricular outflow tract obstruction risk. Post-procedure, the patient exhibited mild mitral regurgitation, stable hemodynamics, and significant clinical improvement. DISCUSSION: This case highlights TMVR's potential for treating complex mitral valve disease with challenging anatomy.