Balloon Fracturing Valve-in-Valve: How to Do It and a Case Report of TAVR in a Rapid Deployment Prosthesis

Figure 7

Step-by-step procedure. (a) Predilatation and valve cracking using an Atlas 20 mm noncompliant balloon while injecting contrast in the ascending aorta to simultaneously evaluate the left coronary artery flow. (b) Immediate prosthesis cracking and expansion with mean gradient reduction and PVL resolution. (c) Slow Evolut R 23 deployment immediately below the previously implanted rapid deployment valve. (d) Aortic regurgitation reduction on TEE and expansion of the previously implanted rapid deployment valve. (e) Final aortogram showing no aortic regurgitation and both prostheses proper expansion with a mean gradient of 8 mmHg.

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