Valve-in-valve with high risk of coronary obstruction in a degenerated self expandable TAVI

75-years old female patient with a degenerated transcatheter heart valve (THV) (Evolut R 29mm) implanted 6 years earlier presented with dyspnea. Echocardiography showed a mean gradient of 39mmHg, moderate aortic insufficiency and normal left ventricle function. Computed tomography (CT) showed short distance from coronary ostia to aorta and calcified leaflets of the THV. Transfemoral transcatheter aortic valve implantation (TAVI) in TAVI. A 23mm Sapien3 Ultra valve was implanted with Chimney Stenting technique for both coronary arteries. Echocardiographic transaortic valvular mean gradient afterwards was 15mmHg and minimal paravalvular insufficiency.