The annulus size by CT was 19 - 27 mm and annulus area was 402 mm2. After discussion, we decided to implant Edwards SAPIEN 3 23 mm with 1.5cc overfill. Under monitored anesthesia control, 6 Fr sheath and temporary pacemaker was 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 a puncture site of right femoral artery. 8 Fr sheath was inserted through right femoral artery, and then one Proglide devices were placed into the right femoral artery. After removal of the sheath, right femoral artery was dilated and 14 Fr Edwards E-sheath was inserted. An AL 1 diagnostic catheter with a 0.035 inch amplatz stiff wire was used to cross the aortic valve. Under fluoroscopy, a 23-mm Edwards SAPIEN 3 prosthesis crimped on the delivery catheter (NovaFlex Delivery System) was placed at the best position of the aortic annulus, almost half and half at the annulus level, and was successfully deployed by inflating the balloon under rapid ventricular pacing ( Movie 1). After valve implantation, final fluoroscopy showed well positioned Edwards valve without significant AR. ( Movie 2). After the intervention, puncture site was sutured by prepared one Proglides.
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