Considering the size of Core Valve on the CT, we planned to use 29 mm Evolute R valve through right femoral artery. Under general anesthesia care, 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 preclosure with Proglide device was done. And then, right femoral artery was dilated and 18 Fr Sentrant sheath was inserted. Aortic root angiography was done ( Movie 1) and an AL 1 diagnostic catheter with a 0.035 inch Amplatz stiff wire was used to cross the aortic valve. The 14 Fr Core Valve EVOLUT-R delivery catheter system (AccuTrak) was advanced gently into the vessel. The Core Valve EVOLUT-R crossed over pre-existing Core valve using the super-stiff wire and deployment was done around 5 mm above lower margin of the pre-existing Core Valve ( Movie 2). Final Aortic root angiography showed mild Aortic regurgitation ( Movie 3). After the intervention, puncture site was sutured by prepared Proglide device.
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