case_images: PMC6904954_01
case_images: Critical stenosis of the distal LM involving the trifurcation with LAD, LCx, and intermediate branch (A). A provisional approach was chosen to treat the LM bifurcation with sequential ballooning of RI and LCx (B) and the result after stent implantation in LM-RI and final kiss-balloon inflation (C).
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case_images: PMC6904954_01_fcvm-06-00174-g0001.jpg
case_images: F1
case_images: The patient underwent PCI to left main coronary artery and intermediate branch (provisional approach to the bifurcation with LCx). The procedure was uncomplicated with good angiographic result (Figure 1).
case_images: CT reconstruction showing the relationship between aortic and mitral bioprostheses. The aorto-mitral angle of 134  is associated with a low risk of LVOT obstruction.
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case_images: PMC6904954_01_fcvm-06-00174-g0002.jpg
case_images: F2
case_images: In particular, neo-LVOT estimated area was well-above the described cutoff of 250 mm2, and the calculated aorto-mitral angle was not indicative of high risk (Figure 2).
case_images: VA ECMO. (A) Arterial cannula (21 F) in left common femoral artery; (B) venous cannula (23 F) in right internal jugular vein; (C) arterial access closure with two preimplanted Proglides and intravascular hemostasis (10 x 20 mm peripheral balloon); (D) angiographic control showing good result on site of arterial access.
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case_images: PMC6904954_01_fcvm-06-00174-g0003.jpg
case_images: F3
case_images: Abbott Park, IL) on the arterial access. After positioning of the vascular cannulas, MCS was started with a flow rate of 2.1 L/min (Figure 3).
case_images: Main steps of the implantation procedure: in (A), the mitral valve was crossed with a supportive pre-shaped wire and the Mullins' sheath. (B) Shows valve deployment under rapid pacing. (C) Shows final echographic result with the valve correctly positioned in the mitral ring with no significant leak and acceptable 5 mmHg transvalvular gradient (D).
case_images: fcvm-06-00174-g0004.jpg
case_images: PMC6904954_01_fcvm-06-00174-g0004.jpg
case_images: F4
case_images: Echocardiography revealed only trivial paravalvular leak, absence of LVOT obstruction and mean trans-mitral diastolic gradient of 5 mmHg (Figure 4).