case_images: PMC11166197_01
case_images: (A) Three-chamber view in CT simulation, predicting an end-diastolic neo-LVOT of 10.6 mm (*). The simulated alignment area of the aortic (29 mm S 3, blue line) and mitral prosthesis (green cage) is marked by the dotted orange line. The red line indicates the ascending aorta. (B) Fluoroscopy at the end of the procedure: 29 mm S 3 (arrow a) and the overlapping crown of the 29 mm Tendyne valve (low profile, arrow b) are fully deployed without interference. (C) Postprocedural MRI documenting the well-placed intra-annular position of Tendyne valve (arrow a) and its distal part targeting the anterior leaflet (hyperintense, arrow b, length 23.4 mm). The ascending aorta (red line), the cylinder of the S3 (blue line), the implanted Tendyne  stent (green line) and the overlapping area (dotted orange line) are highlighted. No LVOT-obstruction. (D) Optimal alignment (orange dotted line) of the S3 (blue line) and Tendyne prothesis (green line) on postoperative MRI. The circular inner frame of the Tendyne valve with porcine pericardial leaflets (*) is mounted on a self-expanding outer frame.
case_images: fcvm-11-1373840-g001.jpg
case_images: PMC11166197_01_fcvm-11-1373840-g001.jpg
case_images: F1
case_images: Special attention was paid to the neo-LVOT, which was predicted to have 10.6 mm (Figure 1A). Fluoroscopy by the end of the procedure confirmed optimal valve positioning (Figure 1B). Postoperative magnetic resonance imaging (MRI) showed optimal positioning of the prosthesis in the mitral anulus without any sign of paravalvular leakage, which was confirmed by echocardiography (Figures 1C,D).