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.