THV-in-THV for non-SVD related malfunction

This is a case of a balloon-expandable valve implantation in malfunctioning self-expanding (SE) prosthesis. The SE prosthesis was implanted one week previously to treat heavily calcified stenotic bicuspid aortic valve with final under-expansion and multiple intra– and paraprosthetic jets causing severe aortic regurgitation. The presentation follows a pre-procedural THV-in-THV checklist with the emphasis on the simulation and assessment of the neosinus. After aggressive post-dilatation that did not fully expand the SE prosthesis, an oversized and over-expanded Sapien valve was implanted with the achievement of adequate expansion, circular shape and significant reduction of regurgitation.