Before procedure	A 90-year-old patient with dyspnoea on exertion was found to have severe aortic stenosis with a peak trans-valvular jet velocity of 4.1 m/s. Considering her age, frailty and the risk for surgical aortic valve replacement, she was referred for transcatheter aortic valve implantation (TAVI)
0:00	General anaesthesia was initiated for TAVI
00:45	Temporary pacemaker was placed
01:50	First attempt at advancing the expandable sheath from left femoral artery failed, and the wire was exchanged to Lunderquist, without success
02:02	A buddy wire was added, but the expandable sheath did not advance
02:17	Balloon angioplasty was performed at the abdominal aorta, and the sheath advanced
02:29	Heparin added, and activated clotting time (ACT) was 307 s
02:50	A guidewire was placed in the left coronary artery to prevent obstruction
02:54	ACT was 298 s. The balloon aortic valvuloplasty was applied under rapid pacing
03:09	Delivery system was advanced
	Transoesophageal echography (TOE) showed the sudden appearance of a high-echoic mass attached to the valve
03:18	The transcatheter heart valve (THV) was implanted under rapid pacing
03:20	The intracardiac mass grew in length and moved in and out of the left ventricle
03:29	The mass detached from the THV and flowed up the ascending aorta, disappearing from the TOE screen
03:40	ACT was 347 s
04:07	Cerebral angiography was performed, and no major cerebral trunk was occluded
04:34	The sheaths were extracted, and the procedure was over
Post- procedure	The patient presented with hemianopsia and ataxia. Acute cerebral infarction was found in magnetic resonance imaging. After rehabilitation, the patient was able to walk independently with score 3 on the modified Rankins scale