Considering the annulus size by MR and TEE, we planned to use 23 mm Edwards SAPIEN 3 valve through right 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 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 pre-closure with one Proglide¢â device was done. And then, right femoral artery was dilated, and 14 Fr Edwards E-sheath was inserted. 9Fr long sheath was inserted to Lt femoral vein to manipulate intracardiac echocardiography. An AL 1 diagnostic catheter with a 0.035-inch amplatz stiff wire was used to cross the aortic valve. Considering little amount of calcium of aortic valve, we planned valve implantation without pre-dilatation. Under fluoroscopy control, 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, half and half at the annulus level with minimal contrast agents and was successfully deployed by inflating the balloon under rapid ventricular pacing ( Movie 1). After valve implantation, we performed ICE and TTE to check AR which showed trivial degree ( Movie 2). And then, we removed Edward 14 Fr sheath, checked the right peripheral angiogram and closed puncture site by Proglide device. Total amount of contrast dye used was 30 cc.
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