The annulus size by CT was 22.6 - 29.7 mm, perimeter was 84.2 mm. After discussion, we selected the 29mm Edwards SAPIEN XT valve. We planned trans-apical approach cause of severe atherosclerosis and mobile atheroma at aortic arch and small diameter of both ileofemoral arteries. Under general anesthesia, 5 Fr sheath and pig-tail catheter were inserted through left radial artery and trans-apical thoracotomy was done. Puncture of LV apex was followed through trans-apical thoracotomy site with 6 Fr sheath and exchanged to the delivery catheter. Under fluoroscopy control, a 29 mm Edwards SAPIEN XT prosthesis crimped on the delivery catheter (NovaFlex Delivery System) and placed at the best position of the aortic annulus. Then it was successfully deployed by inflating the balloon under rapid ventricular pacing and aortic root angiography. ( Movie 1, Movie 2) Final fluoroscopy showed well positioned Edwards Valve without significant paravalvular leakage. ( Movie 3) And then we removed delivery system and closed thoracotomy site.
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