The annulus size by CT was 18.9 - 24.7mm, perimeter was 72.5mm. After discussion, we selected the 26mm sized CoreValve EVOLUT-R. 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 Ultimum sheath was placed. And then, an AL 1 diagnostic catheter with a stiff wire was used to cross the aortic valve. After crossing AV, the stiff wire was replaced by a super-stiff wire, and then we did predilation using Z-MED II balloon 20mm x 4cm ( Movie 1). The 18 Fr CoreValve EVOLUT-R delivery catheter system (AccuTrak) was advanced gently into the vessel. The Core Valve EVOLUT-R crossed over AV using the super-stiff wire and deployment was done. Immediately after valve implantation, root angiography showed all coronary arteries was patent and minimal paravavular regurgitation ( Movie 2). Final fluoroscopy showed well positioned CoreValve EVOLUT-R ( Movie 3). After the intervention, puncture site was sutured by prepared two Proglides. There were no vascular or AV block complication.
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