Fatal coronary obstruction despite BASILICA, which inspired development of balloon-augmented BASILICA. A) Pre-procedure CT showing a diffusely calcified left coronary leaflet, short left main, and small sinuses of Valsalva. B) Pre-procedure CT planning demonstrating high risk for coronary occlusion due to VTC and VTSTJ of 0. C) Autopsy findings with native leaflet pinned by TAVR valve, crushing rescue left main stent. D) Autopsy findings showing rigid, diffusely calcified leaflet with limited splay despite BASILICA.
Abbreviations: L – left, LM – left main, R – right, SOV – sinus of Valsalva, TAVR – transcatheter aortic valve replacement, VTC – valve to coronary distance, VTSTJ – valve to sinotubular junction distance