Excerpt

An 85-year-old woman was admitted for transcatheter aortic valve implantation (TAVI) to treat severe symptomatic aortic stenosis (AS). Her cardiac history included permanent atrial fibrillation. Transthoracic echocardiogram indicated moderate left ventricular dysfunction (ejection fraction, 44.8%) with severe AS and moderate aortic regurgitation (AR). Transesophageal echocardiogram (TEE) and computed tomography (CT) revealed valve morphology of a quadricuspid aortic valve (QAV) defined as type C by the QAV classification (Fig. 1a, b) [1]. The Heart Team decided to perform TAVI because of her frailty. The valve size was determined by the annular area (372 mm²) and the optimal perpendicular angle was planned by volume rendering CT images (Fig. 1c). The procedure was performed under general anesthesia via transfemoral approach. A 23-mm balloon-expandable transcatheter heart valve (THV) (SAPIEN 3™, Edwards, Irvine, CA, USA) was deployed (Fig. 1d) under angiographic guidance. After the procedure, AS and AR markedly improved (mean gradient: from 47.9 to 16.0 mmHg, effective orifice area 0.6–1.2 cm², calculated AR index 43.2, AR grade: from moderate to trivial on an aortogram (Fig. 1e, Video 1) and TEE (Fig. 1f, Video 2; Fig. 1g, Video 3).

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