PMC10449538_01
Timeline of care.
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F1
The patient was transferred to our center for further evaluation of possible treatment options (patient characteristics available in Supplementary S1, Timeline in Figure 1).
CT angiography following TAVI protocol: (A) EvolutR TAVI valve with graft repair and aortic aneurysm with type A dissection of the ascending aorta and proximal arch. Severe tortousity of the iliac arteries. (B,C) Type A aortic dissection in the transverse plane.
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F2
(A) Myval 26 mm positioning no predilation. Good angiographic result with no regurgitation. The position of the valve was at the level of the natural annulus. We avoided overextension of the neo-skirt. (B,C) Unobstructed coronary ostia with good patency.
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F3
Supplementary Figures S3, S4). Severe tortuosity of the iliac arteries was evident upon 3D reconstruction. Control selective coronary angiography showed good patency of the coronary arteries, and control aortography showed good alignment of the prosthetic valve with no residual aortic regurgitation (Figure 3).
(A) Postoperative x-ray of the dual-chamber pacemaker with the atrial lead positioned in the right atrial appendage and the ventricular lead positioned transeptally for left bundle branch pacing (LBBP). (B) (Left) Initial QRS complex with left bundle branch block morphology. (Right) Final QRS duration after atrio- ventricular delay optimization.
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F4
Supplementary Figures S3, S4). Severe tortuosity of the iliac arteries was evident upon 3D reconstruction. The right atrial lead was then positioned in the RA, and the atrioventricular delay was optimized to achieve the shortest QRS duration (Figure 4).