Valve-in-valve implantation due to malposition of transcatheter aortic valve applied by coronary guide wire protection in presence of lower-lying coronary ostium

Although transcatheter aortic valve implantation is an important procedure in the treatment of severe aortic stenosis with a high-operative risk today, technological difficulties and limitations still exist. Life-threatening complications, such as coronary artery occlusion, are considered potential risks. The presence of low coronary ositum distance is one of the major limitations of the transcatheter aortic valve implantation. An impaired coronary blood flow during transcatheter aortic valve implantation results from the presence of a low coronary ostium height. In case of short distance between the coronary ostium and valve, a detailed preoperative evaluation should be performed and additional precautions should be taken during the transcatheter aortic valve implantation to avoid coronary obstruction. Coronary occlusion at a lower rate can be achieved, if a shorter prosthesis is placed too low as possible into the aortic annulus. In this article, we report an 82-year-old female case of low coronary ostium height at high-risk for surgery due to severe aortic stenosis, in whom valve-in-valve implantation was performed using coronary guidewire protection due to the malposition of the first valve