case_images: PMC5882041_01
case_images: Transesophageal echocardiography guided implantation of a 20-mm Edwards Sapien 3 valve inside a 21-mm Mitroflow bioprosthesis.
case_images: 10.1177_2324709618767696-fig1.jpg
case_images: PMC5882041_01_10.1177_2324709618767696-fig1.jpg
case_images: fig1-2324709618767696
case_images: Transfemoral implantation of a 20-mm Edwards Sapien 3 valve inside 21-mm Mitroflow bioprosthesis under the guidance of transesophageal echocardiography was initially uneventful (Figure 1).
case_images: Coronary angiography showing Mitroflow leaflet overriding the left main coronary ostium with poor flow in left coronary artery.
case_images: 10.1177_2324709618767696-fig2.jpg
case_images: PMC5882041_01_10.1177_2324709618767696-fig2.jpg
case_images: fig2-2324709618767696
case_images: Urgent coronary angiography revealed Mitroflow leaflet overriding the LM ostium with poor flow in the left coronary artery (Figure 2).
case_images: Insertion of left main coronary wire and balloon behind the Sapien 3 valve following inability to cross the upper cells of Edwards Sapien 3 valve due to obstruction by the Mitroflow bioprosthetic valve leaflet.
case_images: 10.1177_2324709618767696-fig3.jpg
case_images: PMC5882041_01_10.1177_2324709618767696-fig3.jpg
case_images: fig3-2324709618767696
case_images: Upper cells of Edwards Sapien 3 valve could not be crossed because of obstruction by the prosthetic valve leaflet, so the LM artery was wired and ballooned behind the Sapien 3 valve (Figure 3).
case_images: Two bare metal stents effectively scaffolding the Edwards Sapien 3 valve and providing a new channel towards the left main coronary artery.
case_images: 10.1177_2324709618767696-fig4.jpg
case_images: PMC5882041_01_10.1177_2324709618767696-fig4.jpg
case_images: fig4-2324709618767696
case_images: Two bare metal stents were needed to scaffold the Edwards Sapien 3 valve efficiently and to provide a new LM coronary artery channel (Figure 4).