case_images: PMC11830255_01
case_images: CT Measurements Obtained Prior to TAVR. Computed tomography (CT) measurements obtained prior to transcatheter aortic valve replacement (TAVR) used for valve sizing. Note larger diameters of aorta compared to annulus. LC = left coronary; LCC = left coronary cusp; NC = noncoronary; NCC = noncoronary cusp; RC = right coronary; RCC = right coronary cusp; SOV = sinus of Valsalva.
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case_images: Computed tomography measurements are presented in Figure 1.
case_images: CT Representation of a Contrast-Filled Structure in the SOV of NCC. A contrast-filled structure was noted in the SOV of NCC in the CT. Etiology of the finding is unknown and it could be related to prior balloon aortic valve angioplasty. Abbreviations as in Figure 1.
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case_images: A contrast-filled structure of unknown origin was observed in the sinus of Valsalva of the noncoronary cusp (Figure 2).
case_images: Position of the Embolized Valve in the AO and ECG Changes Following Embolization. Position of the embolized valve in the aorta (AO) in relation to the aortic annulus marked with yellow line. Immediately after embolization a ST-segment denivelation and bradycardia were noted in electrocardiogram (ECG) strip, which were followed by asystole.
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case_images: However, the valve embolized in the aorta, causing ST-segment denivelation followed by bradycardia and asystole (Figure 3). Aortography revealed the adequate position of the second valve with mild paravalvular regurgitation and patent coronary arteries (Figure 4, Video 3).
case_images: Angiographic Result After the Second Valve Implantation. Angiographic result after the second valve implantation with evidence of mild paravalvular leak and patent coronary arteries.
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case_images: Aortography revealed the adequate position of the second valve with mild paravalvular regurgitation and patent coronary arteries (Figure 4, Video 3). This was confirmed with aortography and opening of the embolized valve leaflets with Lunderquist wire (Cook Medical) (Figure 6, Video 4).
case_images: ST-Segment Elevation Noted After Catheter Removal From Embolized Valve. Electrocardiogram strip demonstrating ST-segment elevation noted after catheter removal from embolized valve.
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case_images: Aortography and ECG After Placement of Wire Through the Embolized Valve. (A) Aortography reveals fully functional embolized valve in ascending aorta disabling retrograde flow in coronary arteries causing global myocardial ischemia. Red lines represent the position of the leaflets of the embolized valve. (B) ECG strip after placement of stiff wire through the embolized valve. ST-segment normalization occurred (as compared to Figure 5). Abbreviation as in Figure 3.
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case_images: This was confirmed with aortography and opening of the embolized valve leaflets with Lunderquist wire (Cook Medical) (Figure 6, Video 4).
case_images: Deployment of the Aortic Stent. Deployment of the aortic stent in the embolized valve. Red arrows indicate point of contact of the stent and frame of embolized valve. The position of the stent is such to fully cover leaflets of the embolized valve and not to interfere with functional valve.
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case_images: Final Aortography and ECG. The final aortography revealing complete expansion of the stent, proper backflow of the blood, and patent aortic arch branches. On stent implantation, there were no ischemic changes noted in the ECG. Abbreviation as in Figure 3.
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