Because the annulus size by TEE and CT was 19.4-25.4 mm, we selected the 23mm sized CoreValve 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 both 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 Ultimum sheath was placed, sequentially. 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 super-stiff wire. The supra-aortic angiogram showed AR grade 3 filling the LV during diastole ( Movie 1). The 18 Fr CoreValve delivery catheter system (AccuTrak) was advanced gently into the vessel. The Core Valve crossed over AV using the super-stiff wire and was deployed. Immediately after valve implantation, root angiography showed all coronary arteries was patent and minimal paravavular regurgitation with well positioned CoreValve ( Movie 2). After the intervention, puncture site was sutured by prepared three Proglides.
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