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When Anatomy Says No: Redefining Mitral Valve Intervention at Atlantic Health Morristown Medical Center
November 2, 2026 | Gennaro Giustino, MD, a structural interventional cardiologist at Atlantic Health Morristown Medical Center, specializes in advanced structural heart interventions for patients with complex valvular disease, including recurrent mitral regurgitation after prior surgical repair.
Clinical Scorecard: When Anatomy Says No: Redefining Mitral Valve Intervention at Atlantic Health Morristown Medical Center
At a Glance
Category
Detail
Condition
Clinical topic addressed by the source article: When Anatomy Says No
Key Mechanisms
Mechanisms or clinical associations described in the source article.
Target Population
Patients referred for structural evaluation with recurrent mitral regurgitation after prior repair, severe mitral regurgitation with elevated pulmonary pressures, anatomy raising concern for obstruction, or high surgical risk.
Care Setting
Care setting described in the source article.
Key Highlights
Prior repair techniques and altered anatomy can constrain transcatheter treatment options.
LAMPOON is described as transcatheter laceration of the anterior mitral leaflet to prevent outflow tract obstruction.
A case illustration describes combined LAMPOON and Alfieri stitch laceration before transcatheter valve deployment.
The case team used preemptive ECMO before leaflet modification in a patient considered at risk of becoming critically ill during the procedure.
The center reports performing 30–40 leaflet modification procedures annually across the aortic, mitral, and tricuspid valves.
Guideline-Based Recommendations
Diagnosis
Management
Monitoring & Follow-up
Risks
Patient & Prescribing Data
Patients with severe or recurrent mitral regurgitation after prior surgical repair, particularly those considered high risk for redo surgery or with anatomy that may obstruct transcatheter treatment.
The article describes individualized structural strategies, including leaflet or stitch laceration and, in one case, preemptive ECMO. It provides no medication prescribing data.
Clinical Best Practices
Consider early structural heart evaluation for the referral situations listed in the article; consultation does not commit the patient to intervention.
The article describes coordinated expertise among interventional cardiology, cardiac surgery, advanced imaging, anesthesia, and heart failure teams.
The article states that complex leaflet modification cases should be treated at high-volume structural heart disease centers.
Higher medical expenses increased financial anxiety and reduced willingness to schedule recommended procedures in 3 studies, with stronger effects among financially stressed participants.
