PMC5882041_01
Transesophageal echocardiography guided implantation of a 20-mm Edwards Sapien 3 valve inside a 21-mm Mitroflow bioprosthesis.
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Transfemoral implantation of a 20-mm Edwards Sapien 3 valve inside 21-mm Mitroflow bioprosthesis under the guidance of transesophageal echocardiography was initially uneventful (Figure 1).
Coronary angiography showing Mitroflow leaflet overriding the left main coronary ostium with poor flow in left coronary artery.
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Urgent coronary angiography revealed Mitroflow leaflet overriding the LM ostium with poor flow in the left coronary artery (Figure 2).
Insertion of left main coronary wire and balloon behind the Sapien 3 valve following inability to cross the upper cells of Edwards Sapien 3 valve due to obstruction by the Mitroflow bioprosthetic valve leaflet.
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Upper cells of Edwards Sapien 3 valve could not be crossed because of obstruction by the prosthetic valve leaflet, so the LM artery was wired and ballooned behind the Sapien 3 valve (Figure 3).
Two bare metal stents effectively scaffolding the Edwards Sapien 3 valve and providing a new channel towards the left main coronary artery.
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Two bare metal stents were needed to scaffold the Edwards Sapien 3 valve efficiently and to provide a new LM coronary artery channel (Figure 4).