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. 2023 Apr 23;10(5):187. doi: 10.3390/jcdd10050187

Figure 2.

Figure 2

(a) Cardiac computed tomography (CCT) scan. Pre-procedural planning of TAVR-in-TAVR procedure in a symptomatic 85-year-old patient with 26 mm Sapien 3 (Edwards LifesciencesTM) valve structural degeneration and previous left main (LM) stent placement; CCT documented LM height of 6.9 mm (A) and Sapien 3 commissures in relation to both coronary arteries (B). (b) Intraprocedural transesophageal echocardiography real-time monitoring of left main stent coronary flow during TAVR-in-TAVR procedure. TAVR-in-TAVR procedure was performed under general anesthesia with intraprocedural TEE guidance; after pre-dilatation with a 24 mm True™ Dilatation Balloon (BDTM) to expand the valve frame, a 29 mm Evolut-FX valve (MedtronicTM) was deployed and finally balloon post-dilatation was performed to treat the presence of paravalvular leak, with excellent result. TEE after deployment documented diastolic flow through the LM stent with color Doppler (A) and normal systolic wave (“S”) and diastolic wave (“D”) velocities with pulsed-wave Doppler (B). There were no ischemic electrocardiographic changes during the procedure.