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Explore a comprehensive case study on valve in ring (ViR) transcatheter mitral valve replacement (TMVR) in a patient with prior surgical mitral repair and symptomatic severe mitral stenosis. Learn about CT assessment for LVOT obstruction risk during TMVR, various LAMPOON techniques to mitigate this risk, and follow a high-risk surgical patient's successful treatment using tip-to-base LAMPOON assisted ViR TMVR. Gain insights into evaluating LVOT obstruction risk based on CT measurements and understand the electrosurgical catheter-based LAMPOON procedure. Review objectives include comprehending LVOT obstruction risks in TMVR, mastering LAMPOON techniques, and analyzing a real-world case study of severe mitral stenosis treatment in a high-risk patient with prior mitral valve repair.