Double chimney stenting and triple kissing balloon inflation to prevent coronary obstruction during valve-in-valve TAVI with balloon valve fracture

Figure 1. A novel way to prevent bilateral coronary obstruction in a high-risk case of valve-in-valve TAVI requiring balloon valve fracture. A) CT highlighted risk of bilateral coronary obstruction, with virtual THV to left coronary ostium (VTC) distance of 3.5 mm. B) Proximal segments of coronary stents protruding into the aortic root to cover the bioprosthetic valve leaflets. C) Inflated stent balloons followed by the 18 mm Atlas Gold balloon. D) MG dropped to 9 mmHg. E) Aortography demonstrated patent coronary arteries and no paravalvular leak. F) Post-TAVI CT showed a well-expanded THV with no stent deformation. CT: computed tomography; MG: mean gradient; ...