Redo aortic valve surgery for failure of a previously implanted valve is
always challenging. In case of small-sized implanted valves, the use of
a balloon-expanding Sapien-3 valve can enhance the final effective
orifice area, avoid complex annulus enlargement techniques, and can
reduce operative time and morbidities. We describe a case where after
explanting a failed 19mm St. Jude mechanical aortic valve and further
deployment of a 23mm Sapien-3 valve, the left coronary ostia was
obstructed by the skirt of the transcatheter prosthesis. After careful
removal of a little part of the skirt, we were able to restore the
coronary flow and the patient had a favorable outcome.