(Figure F).
Two weeks later, the patient underwent valve-in-valve (VIV)
transcatheter aortic valve replacement (TAVR) utilizing a 23 mm Edwards
Sapien Ultra valve under transesophgeal echocardiographic (TEE)
guidance. The valve was deployed somewhat more ventricular than is
typical in order to utilize the valveās sealing skirt to seal the large
area of PVL involving the superior LVOT. Following valve deployment,
additional balloon post-dilatation was performed using a 22mm Tru
Dilatation Balloon (Bard) to deliberately fracture and enlarge the
bioprosthetic surgical valve to further seal the large area of PVL and
to assure optimal transvalvular hemodynamics (Figure G). The
pressure gradient across the aortic valve resolved after TAVR
implantation (Figure H). Final TEE imaging revealed near total
resolution of both PVL and aortic stenosis (Figure I).