A 64-year-old man with severe aortic stenosis and mitral regurgitation
presented to our emergency. He had a New York Heart Association class IV
symptoms with EuroSCORE II of 20%. Heart team decide to perform an
urgent TAVR. The patient commenced cardiogenic shock in operation room.
A Venus 22mm balloon and A 26mm Venus A-Valve were performed
immediately. Aortography and TEE showed a deep implantation, moderate to
severe “supra-skirt” paravalvular aortic regurgitation (PAR) and mild
prosthetic aortic valve stenosis. After evaluating the hemodynamic
tolerability of PAR and the initial mitral regurgitation, the heart team
decided to proceed with aortic valve replacement and mitral valve
replacement rather than valve-in-valve TAVR.