thorough discussion within the Heart Team this patient was treated with medical therapy only. CONCLUSION Virtual simulation of a mitral ViV-procedure using innovative imaging modalities and 3D reconstruction is feasible and correlated very well with the actual patient procedure. This approach is suitable and represents a cost-effective and non-invasive tool to almost eliminate the risk for LVOT obstruction following mitral ViV- procedures. CATEGORIES STRUCTURAL: Valvular Disease: Mitral TCT-642 Intentional Laceration of the Anterior Mitral valve leaflet to Prevent left ventricular Outflow tract ObstructioN (LAMPOON) during transcatheter mitral valve implantation: preclinical findings Jaffar Khan, 1 Toby Rogers, 2 Anthony Faranesh, 3 Adam Greenbaum, 4 Vasilis Babaliaros, 5 Marcus Chen, 6 Robert Lederman 7 1 NHLBI, Bethesda, Maryland, United States; 2 NIH, Bethesda, Maryland, United States; 3 NHLBI, Bethesda, Maryland, United States; 4 Henry Ford Hospital, Detroit, Michigan, United States; 5 Emory University School of Medicine, Atlanta, Georgia, United States; 6 National Institutes of Health, Bethesda, Maryland, United States; 7 National Institutes of Health, Bethesda, Maryland, United States BACKGROUND Left ventricular outflow tract (LVOT) obstruction is a life- threatening complication of transcatheter mitral valve implantation (TMVR), caused by septal displacement of the anterior mitral leaflet. We propose a novel transcatheter transection of the anterior mitral leaflet. METHODS In vivo procedures in swine were guided by biplane X-ray fluoroscopy and intracardiac echocardiography. Retrograde transaortic 6Fr guiding catheters straddled the anterior mitral leaflet. A stiff 0.014” guidewire with polymer jacket insulation was electrified and advanced from the LVOT, through the A2 leaflet base, into the left atrium [Fig. 1A]. The wire was snared and externalized; the resulting wire loop electri- fied and pulled, lacerating the anterior mitral leaflet [Fig. 1B]. RESULTS The anterior mitral leaflet was successfully lacerated in seven live and one post-mortem heparinized swine. Lacerations extended to 89  19% of leaflet length and were located within 0.5  0.4mm of leaflet centerline. The chordae were preserved and retrac- ted the leaflet away from the LVOT. LVOT narrowing after benchtop TMVR was significantly reduced with LAMPOON than without (65%  10% vs. 31  18% of pre-implant diameter, p<0.01). LAMPOON caused mean blood pressure to fall (54  6 to 30  4mm Hg, p<0.01), but remained steady until planned euthanasia. No collateral tissue injury was identified on necropsy. CONCLUSION Using simple catheter techniques we transected the anterior mitral valve leaflet. Cautiously applied in patients, this strategy may prevent anterior mitral leaflet displacement and LVOT obstruction caused by TMVR. CATEGORIES STRUCTURAL: Valvular Disease: Mitral TCT-643 Percutaneous Mitral Valve Repair for Acute Mitral Regurgitation Following an Acute Myocardial Infarction Rodrigo Estevez, 1 Tomas Benito-González, 2 Javier Gualis-Cardona, 3 Laura Romero-Roche, 4 Carlota Hernandez, 5 Mario Castaño, 6 Carlos Cuellas-Ramon, 7 David Alonso, 8 Carmen Garrote, 9 Armando Perez de Prado, 10 Maria Lopez, 11 Norberto Alonso-Orcajo, 12 Abel Garcia del Ejido, 13 Felipe Fernandez-Vazquez 14 JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016 B261