Transcatheter Aortic Valve Implantation in an Extremely Tortuous S-Shaped Aorta

Figure 1

Composite image of a tortuous S-shaped aorta.

(a) Preprocedure computed tomography (coronal view) demonstrating tortuous aorta with calcification

(b) Computed tomography 3D reconstruction of the tortuous aorta

(c) Fluoroscopy image (left anterior oblique projection) demonstrating the tortuous path of the coronary catheter

(d) Fluoroscopy image (anterior posterior projection) demonstrating Lunderquist wire guides in the catheter to straighten out the aorta

(e) Fluoroscopy image (AP caudal projection) demonstrating the Sapien XT valve prior to deployment

(f) Fluoroscopy image (AP projection) demonstrating the deployed Sapien XT valve and the tortuous aorta