case_images: PMC11718390_01
case_images: The preoperative imaging findings for the transcatheter aortic valve implantation procedure are presented. (A) Preoperative transthroracic echocardiography showed severe aortic stenosis and grade 1 aortic regurgitation. (B) Computed tomography revealed a tricuspid aortic valve with mild calcification. (C) Coronary angiography revealed no significant coronary artery stenosis.
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case_images: Transthoracic echocardiography (TTE) showed a normal left ventricular ejection fraction, an aortic valve area of 0.6 cm2, peak velocity of 4.6 m/s, mean gradient of 55.7 mmHg, and grade 1 aortic regurgitation (AR; Figure 1A). Computed tomography showed an aortic annulus area of 369 mm2 and perimeter of 70.6 mm (Figure 1B). Coronary angiography revealed no significant coronary artery stenosis (Figure 1C). Post-dilatation TEE revealed prosthetic valve leaflet motion and severe intraprosthetic regurgitation (Figure 2C, Supplementary material online, Video S1).
case_images: The operative findings during the transcatheter aortic valve implantation procedure are presented. (A) Sapien 3 Ultra RESILIA aortic valve with a diameter of 23 mm was deployed. (B) Transoesophageal echocardiography showed mild paravalvular leak following deployment. (C) Transoesophageal echocardiography demonstrated stuck leaflet and severe intraprosthetic regurgitation. (D) Angiography demonstrated Seller's grade 3 aortic regurgitation. (E) Valve-in-valve procedure was performed. (F) Final transoesophageal echocardiography showed no paravalvular leak or aortic regurgitation.
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case_images: After placing a wire in the left anterior descending artery for coronary protection, the Edwards Sapien 3 Ultra RESILIA aortic valve, with a diameter of 23 mm, was deployed under rapid pacing (Figure 2A). Mild paravalvular leak (PVL) was detected on TEE (Figure 2B), and post-dilatation was performed using a 23 mm balloon. Post-dilatation TEE revealed prosthetic valve leaflet motion and severe intraprosthetic regurgitation (Figure 2C, Supplementary material online, Video S1). Aortography confirmed Seller's grade 3 aortic regurgitation (Figure 2D, Supplementary material online, Video S2). Therefore, a valve-in-valve procedure was performed using the second 23 mm valve (Figure 2E). TEE showed no PVL or aortic regurgitation (Figure 2F, Supplementary material online, Video S3), and haemodynamics improved.
case_images: The post-operative transthoracic echocardiography demonstrated an improvement in pressure gradient, with no evidence of paravalvular leak.
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case_images: TEE showed no PVL or aortic regurgitation (Figure 2F, Supplementary material online, Video S3), and haemodynamics improved. TAVI were observed. Three days after the procedure, TTE demonstrated an effective orifice area of 1.6 cm2, peak velocity of 1.9 m/s, and mean gradient of 7.5 mmHg, with no PVL detected (Figure 3). The patient was discharged on the tenth postoperative day.