(A) The stent (double arrow) is in contact with the anterior mitral leaflet. Prosthetic valve endocarditis 1 year after implantation associated with perforation of the mitral leaflet at the point of contact (single arrow). (B) Ensuing severe mitral regurgitation. (C) In a second patient, prolapse of the anterior mitral leaflet secondary to chordeal rupture created (D) severe mitral regurgitation several months after the procedure. Ao = aorta; LA = left atrium; LVOT = left ventricular outflow tract.