Figure Legends
FIGURE A: Initial transthoracic echocardiographic parasternal
short axis image demonstrating color doppler of large jet of
paravalvular aortic regurgitation.
FIGURE B: Right heart catheterization (RHC) with severely
elevated right ventricular systolic pressure of 102 mm Hg.
FIGURE C: Angiographic image performed during 20mm balloon
inflation showing partial angiographic compromise of the left main
coronary artery.
FIGURE D: Angiographic image showing Palmaz stent inside of the
CP stent to create the neoconduit. Angiography reveals widely patent
left main coronary artery following neoconduit creation.
FIGURE E: Final pulmonary angiography following transcatheter
valve implantation revealing no significant pulmonic regurgitation.
FIGURE F: Right ventricular pressure tracing obtained at the
conclusion of the transcatheter pulmonic valve implantation procedure.
FIGURE G: Aortic root angiography performed pre- and post-TAVR.
Image 1 arrows highlight significant source of perivalvular
regurgitation. Image 2 showing final angiography with resolution of
perivalvular leak after Sapien 3 Ultra implantation followed by
bioprosthetic valve fracturing using a 22 mm Tru Dilatation balloon
(BARD).
Figure H: Hemodynamic tracings obtained pre- and post-TAVR. The
peak-to-peak gradient across the aortic valve went from 45 mmHg to 1
mmHg, and the systemic diastolic pressure increased from 20 mmHg to 60
mmHg following transcatheter aortic valve-in-valve implantation followed
by bioprosthetic valve fracturing.
FIGURE I: Transesophageal echocardiographic images using color
doppler performed pre- and post-TAVR showing near total resolution of
significant perivalvular leak.