Abstract
Abstract We propose a two-stages positioning and inflation of the balloon expanding the Edwards SAPIEN 3 prosthesis during Transcatheter Aortic Valve Implantation (TAVI) in case of a small porcelain aorta, to avoid aortic root (AR) rupture. We scheduled for Trans-apical TAVI an 85-year-old high-risk woman with a narrow and heavily calcified AR (19 × 20 mm at sino-tubular junction). A 23 mm Edwards Sapien3 prosthesis was directly implanted (without pre-valvuloplasty). First balloon-dilatation was performed in standard position till 70% of nominal inflation volume, in order to hook the prosthesis within the native calcified valve in the correct position. Then the balloon was completely deflated and withdrawn down into the left ventricle, with the distal tip just below the calcified and small aortic sino-tubular junction. In this position, a second balloon-dilatation was performed till 100% of nominal inflation volume to complete prosthesis expansion. Peri-operative trans-esophageal echocardiography showed no paravalvular leak and good trans-prosthesis gradients.
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