case_images: PMC5977029_01
case_images: Cardiac computed tomography angiography showed severely calcified aortic leaflets with short and low left coronary system with coronary ostial height of 8.4 mm.
case_images: CRIC2018-2758170.001.jpg
case_images: PMC5977029_01_CRIC2018-2758170.001.jpg
case_images: fig1
case_images: Cardiac computed tomography angiography was done as part of transcatheter aortic valve replacement evaluation and showed severely calcified aortic leaflets with short and low left coronary system with coronary ostial height of 8.4 mm (Figure 1).
case_images: Balloon aortic valvuloplasty, notice the deformed wires and the large piece of calcium in the left cusp moved right over the left main coronary artery (arrows). Simultaneous aortic root injection showing decreased coronary flow TIMI-2. Echocardiogram demonstrated severe aortic stenosis with mean aortic valve pressure gradient of 68.6 mmHg and peak velocity of 5.15 m/s.
case_images: CRIC2018-2758170.002.jpg
case_images: PMC5977029_01_CRIC2018-2758170.002.jpg
case_images: fig2
case_images: With rapid ventricular pacing over a long Amplatz extra stiff wire, balloon aortic valvuloplasty using an Edward 4 x 23 mm balloon with simultaneous root aortography to see how the left main flow was performed (Figure 2). There was flow compromise in the left main system to TIMI-2 flow; the wires were deformed and the large piece of calcium in the left cusp moved right over the left main coronary artery (Figure 2).
case_images: Final pictures demonstrating implantation of the Edward S3 valve with the kissing stents deflated prior and the final results after final implantation.
case_images: CRIC2018-2758170.003.jpg
case_images: PMC5977029_01_CRIC2018-2758170.003.jpg
case_images: fig3
case_images: An Edward 23 mm SAPIEN 3 valve with rapid ventricular pacing was then deployed followed by deploying the two stents in a kissing fashion, and an excellent result was obtained (Figure 3).