case_images: PMC11770386_01
case_images: A pre-operative multislice computed tomography scan showed the following: Arrows indicate extensive calcification of the leaflet tips of the non-coronary cusps (A, C, and D). Arrows indicate continuous calcification of the left ventricular outflow tract (B). Computed tomography angiography revealed advanced calcification of the artery (E). NCC, non-coronary cusp; RCC, right coronary cusp; LCC, left coronary cusp.
case_images: ytaf015f1.jpg
case_images: PMC11770386_01_ytaf015f1.jpg
case_images: ytaf015-F1
case_images: A pre-operative computed tomography scan identified a massively calcified nodule at the non-coronary cusp (NCC) and the icicle-shaped calcification at the left coronary cusp (LCC) side of LVOT, prompting the selection of a SEV (Figure 1A-D). The left common iliac artery (CIA) was occluded, with a minimum lumen diameter of the right CIA measuring 4.5 x 7.5 mm (Figure 1E).
case_images: Fluoroscopic images of the first deployment, failed re-sheathing, and final deployment: non-uniform expansion in the dotted area during the first deployment (A), failed re-sheathing. The delivery system capsule has stopped re-sheathing (B). The arrows indicate capsule deformation (C). After prosthesis deployment (D).
case_images: ytaf015f2.jpg
case_images: PMC11770386_01_ytaf015f2.jpg
case_images: ytaf015-F2
case_images: During deployment, non-uniform expansion (NUE) of the valve was identified (Figure 2A), prompting an attempt to recapture and reposition the prosthesis. The re-sheathing procedure was initiated; however, approximately one-third of the Navitor valve remained outside the delivery capsule (Figure 2B). Despite the complete advancement of the re-sheathing ring handle, the delivery system capsule failed to re-sheath the valve, and the capsule exhibited deformation (Figure 2C). Fortunately, the NUE resolved following redeployment, achieving optimal positioning with the prosthesis seated 3 mm below the basal ring on the NCC side and 4 mm below the LCC side (Figure 2D).
case_images: The Navitor delivery system after surgery. The tip of the capsule appears deformed, suggesting interference by the calcification at the site of the red arrow (A). The proximal part of the capsule is shortened, as indicated by the arrow (B).
case_images: ytaf015f3.jpg
case_images: PMC11770386_01_ytaf015f3.jpg
case_images: ytaf015-F3
case_images: Upon careful assessment of the removed device, it was noted that the proximal part of the capsule was shortened, with its tip dilated and deformed (Figure 3).