The annulus size by CT was 20.8 - 24.7 mm, perimeter was 74.2 mm. After discussion, we selected the 26mm Edwards SAPIEN XT valve for implantation. Under general anesthesia, 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7 Fr sheath and 6 Fr pig-tail catheter were inserted through left femoral artery. After right peripheral angiogram with pig-tail catheter, we checked proper puncture site of right femoral artery. 8 Fr sheath was inserted through right femoral artery, and then two 8 Fr Proglide devices were placed into the right femoral artery. After removal of the sheath, 18 Fr Edwards E-sheath was inserted. An AL 1 diagnostic catheter with a 0.035-inch stiff wire was used to cross the aortic valve. After crossing AV, the stiff wire was replaced by a 0.035-inch Lunderquist super-stiff wire, and then predilatation of the stenotic AV was undertaken with a 23 x 40 mm Edwards transfemoral balloon under rapid ventricular pacing and aortic root angiography ( Movie 1). Under fluoroscopy control, a 26-mm Edwards SAPIEN XT prosthesis crimped on the delivery catheter (NovaFlex Delivery System) was placed at the best position of the aortic annulus and then it was successfully deployed by inflating the balloon under rapid ventricular pacing and aortic root angiography ( Movie 2). After valve implantation, mild paravalvular leakage was seen in fluoroscopy ( Movie 1). Additional balloon dilatation was done for paravalvular leakage. After balloon dilatation, final fluoroscopy showed well positioned Edwards Valve ( Movie 4) without significant paravalvular leakage. And then, we removed Edward 18 Fr sheath, checked the right peripheral angiogram ( Movie 5). The puncture site was sutured by prepared two Proglide devices.
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