Because the annulus size was measured 22.6-28.7 mm, we selected the 26 mm 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. 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 stiff wire, and then predilatation of the stenotic AV was done with a 20 x 40 mm Z-MED II transfemoral balloon under rapid ventricular pacing and aortic root angiography ( Movie 2). And then, under TEE and fluoroscopic guidance, a 26-mm Edwards SAPIEN XT prosthesis was deployed by inflating the balloon up to 23.5-mm, regarding the large amount of calcium and the shorter perimeter than the reference ( Movie 3). As fluoroscopy showed moderate AR ( Movie 4), additional balloon dilatation up to 24.5-mm was done ( Movie 5). After balloon dilatation, final fluoroscopy revealed well positioned Edwards Valve with much reduced AR amount, grading mild AR ( Movie 6). Then, we removed Edward 18 Fr sheath, checked the left peripheral angiogram and sutured punctured site by prepared two Proglide devices.
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