Considering the annulus size by TEE and CT was 21.0-26.9 mm and small right femoral artery, we planned to use 26 mm Edwards SAPIEN 3 valve through left femoral artery. Under monitored anesthesia care, 6 Fr sheath and temporary pacemaker were inserted through right femoral vein, and 7 Fr sheath and 6 Fr pig-tail catheter were inserted through right femoral artery. After both peripheral angiogram with pig-tail catheter, we checked proper puncture site of left femoral artery. 8 Fr sheath was inserted through left femoral artery, and then one 8 Fr Proglide devices were placed into the left femoral artery. Left femoral artery was dilated, 14 Fr Edwards E-sheath was inserted, sequentially. An AL 1 diagnostic catheter with a 0.035 inch stiff wire was used to cross the aortic valve. Aortic root angiography was done. ( Movie 1). And then, under TEE and fluoroscopy control, a 26-mm Edwards SAPIEN 3 prosthesis crimped on the delivery catheter (NovaFlex Delivery System) was placed at the best position of the aortic annulus, half and half at the annulus level, and was successfully deployed by inflating the balloon under rapid ventricular pacing ( Movie 2). After valve implantation, final fluoroscopy showed well positioned Edwards valve with trivial AR. ( Movie 3). And then, we removed Edward 14 Fr sheath, checked the left peripheral angiogram and sutured puncture site by prepared Proglide device.
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