case_images: PMC11112030_01
case_images: (A) The preoperative transthoracic echocardiogram in diastole showing severe AR and (B) absence of annulus and leaflets calcification. A preoperative computed tomography evaluation (C,D) showing a large sinus of Valsalva and sinus tubular junction. (E) No annulus of leaflets calcification. (F) Aortic angulation.
case_images: fcvm-11-1383264-g001.jpg
case_images: PMC11112030_01_fcvm-11-1383264-g001.jpg
case_images: F1
case_images: Electrocardiography revealed sinus rhythm and increased QRS voltage (Figure 1). Notably, the aortic angulation was 62 , which increases the surgical complexity for a patient with PNAR (Table 1, Figure 1).
case_images: (A) An excessively deep implantation of the valve in the left coronary sinus (black arrow). (B) The coaxiality with and without SACOT. (C) SACOT continuously optimizing THV coaxiality during deployment. (D) Successful implantation. SACOT, snare-assisted coaxiality optimized technique during valve deployment.
case_images: fcvm-11-1383264-g002.jpg
case_images: PMC11112030_01_fcvm-11-1383264-g002.jpg
case_images: F2
case_images: Despite our attempts to position the valve as high as possible, the lack of coaxial alignment led to an excessively deep implantation of the valve in the left coronary sinus (Figure 2A). This led to a more optimal implantation depth below the left coronary sinus (Figures 2B-D).
case_images: The follow-up computed tomography showing a will-positioned THV.
case_images: fcvm-11-1383264-g003.jpg
case_images: PMC11112030_01_fcvm-11-1383264-g003.jpg
case_images: F3
case_images: TTE before discharge, the LVEDd had decreased to 56 mm, and no residual AR was observed. The CT scan confirmed proper positioning and normal function of the THV (Figure 3).