case_images: PMC10783643_01
case_images: Transthoracic echocardiography with calcified aortic valve and severe normal flow/high gradient stenosis, mean gradient of 50 mmHg, and calculated valve orifice area of 0.8 cm2.
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case_images: Transthoracic echocardiogram revealed a severe AS with a valve area of 0.7 cm2 and mean transvalvular gradient of 50 mmHg (Figure 1).
case_images: Pre-procedural computed tomography (CT) scan: (A) aortic annulus of 21.5 mm, area of 357 mm2, and perimeter of 67.8 mm; (B) aortic valve calcification, (C) distance from annulus to left coronary artery, (D) femoral vessel; (E) right subclavian artery; (F) left subclavian artery; and (G) ascending aorta with sufficient length from annulus to brachiocephalic arteries.
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case_images: Both femoral arteries and both subclavian arteries were unsuitable for TAVI access (Figure 2).
case_images: (A) Angiogram of the aortic root prior to valve implantation; (B) 21 Fr Certitude Sheath placed in the aortic and balloon pre-dilation under rapid pacing; (C-E) angiographic positioning of the Acurate Neo 2 valve system; and (F) final angiography with optimal position of the valve and patent coronary arteries.
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case_images: The final angiogram displayed good valve position with patent coronary arteries (Figure 3).