INTROTUCTION
Transcatheter aortic valve replacement (TAVR) has revolutionized the
treatment of symptomatic severe aortic stenosis (AS) (1). In the last
decade, TAVR was approved from inoperable to low surgical risk patients
based on the results of landmark randomized trials (2-5). As TAVR
indications continue to expand, along with the advancement of devices
and technical skills, more patients with poor vascular access or
challenging anatomy once considered illegible for TAVR may be attempted.
Because of the physical limitation of currently available transcatheter
heart valves (THV) sizes, AS patient with extremely large aortic annulus
(ie., area > 683 mm2 or perimeter
> 94 mm) is contraindicated for TAVR. However, several case
series have demonstrated the feasibility of over-expansion of a 29 mm
SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) in patients with
aortic annulus area between 683~800
mm2 (6-9). We report the following successful THV
implantation in a severe tricuspid AS patient with aortic annulus area
>800 mm2, the largest in the literature
to the best of our knowledge.