Clinical introduction
A man in his 60s with severe symptomatic aortic stenosis was scheduled for transcatheter aortic valve implantation (TAVI). His clinical workup showed bicuspid aortic morphology with a valve area of 0.7 cm2, mean gradient of 48 mm Hg and preserved left ventricular function. He had a history of chronic obstructive pulmonary disease and chronic liver disease, resulting in oesophageal varices. He was deemed a high surgical risk by the Heart Team given his comorbidities. He was suitable for a transfemoral approach without prohibitive calcified aortic valve leaflets or raphe.
The TAVI procedure was performed via the right femoral artery for valve delivery and the right radial artery for pigtail catheter. Following predilatation of the native aortic valve, the patient developed severe chest pain with significant inferior ST-segment elevation on ECG. Selective right coronary angiogram revealed proximal occluded vessel (figure 1A). The occlusion site was navigated using…
