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case_images: Preoperative TEE: Aortic valve leaflets, calcification, and regurgitation observed in the short-axis section of preoperative TEE. Key abbreviations: LA - left atrium; LV - left ventricle; AO - aorta; RVOT - right ventricular outflow tract.
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case_images: TEE revealed moderate calcification, leaflet thickening, and hypertrophy of the tricuspid aortic valve (Fig. 1). The valve leaflets were restricted in motion, with a calculated maximum valve area of ~1.1 cm2 using the continuity equation.
case_images: Preoperative TEE: Short-axis view reveals left-to-right atrial septal shunt with a 9 mm blood flow beam (indicated by arrow). Abbreviations: LA - left atrium; LV - left ventricle; AO - aorta.
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case_images: Additionally, a 9 mm-wide ASD was found in the mid-septal region (Fig. 2), with residual lengths on either side.
case_images: Intraoperative TEE: Long-axis aortic view displays a 4.5 mm-wide perivalvular blood flow bundle around the aortic valve (arrow). Abbreviations: LA - left atrium; LV - left ventricle; RV - right ventricle; AO - aortic.
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case_images: TEE monitoring confirmed excellent cardiac function, disappearance of aortic valve regurgitation, secure anchoring of the aortic valve prosthesis, and no obstruction to the mitral valve leaflets or coronary ostia. The aortic valve velocity and pressure gradient upstream of the valve decreased compared to preoperative values, with a maximum velocity of 166 cm/s and a pressure gradient of 11 mmHg (Fig. 3).
case_images: Intraoperative TEE: Long-axis aorta section shows a 1.5 mm-wide paravalvular blood flow beam, demonstrating significant improvement. Abbreviations: LA - left atrium; LV - left ventricle; RV - right ventricle; AO - aorta; MV - mitral valve.
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case_images: However, a periprosthetic leak with a residual width of ~4.5 mm was observed at the self-expanding valve's interface with the native annulus (Fig. 4).
case_images: Intraoperative TEE: Post-release of self-expanding valve, aortic valve's maximum flow velocity measures 166 cm/s, with a pressure difference of 11 mmHg (B), a significant improvement compared to pre-surgery (A: maximum flow velocity of 336 cm/s, pressure difference of 45 mmHg).
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case_images: Postdilation, TEE monitoring showed a reduction in the periprosthetic leak to 1.5 mm (Fig. 5), a significant improvement compared to predilation.
case_images: Postoperative DSA: Self-expanding valve holder's shape and position (thin arrow) are normal, while left and right coronary artery openings (thick arrow) are unobstructed with clear blood flow.
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case_images: The closure device was securely positioned in the atrial septum, and TEE examination showed no deformation or impingement of the self-expanding valve (Fig. 6).