Transcatheter Lotus valve implantation in a regurgitant SAPIEN 3 valve

An 88-year-old male underwent a transcatheter aortic valve implantation with a 26 mm Edwards SAPIEN 3 (S3) valve (Edwards Lifesciences Inc., Irvine, CA, USA) with mild residual paravalvular regurgitation (PAR) after post-dilatation with a 26 mm balloon (Moving image 1). The upper row of Figure 1 illustrates the S3 positioning during expansion (left) with mild PAR by transoesophageal echocardiography (middle) and contrast angiography (right). Transthoracic echocardiography at follow-up (second row) revealed severe PAR (Moving image 2). The pathophysiology of this deterioration to severe PAR is uncertain. S3 sizing and positioning seemed adequate and recoil was excluded. Damage to the S3 integrity by post-dilatation cannot be ruled ...