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A 59-year-old woman with trisomy 21 underwent heart team discussion for symptomatic severe aortic stenosis. Investigations revealed a type I bicuspid aortic valve with minor calcification, normal coronary arteries, preserved left ventricular function and small aorta but adequate coronary height. Heart team decision, factoring patient and family preference, was for transcatheter aortic valve implantation (TAVI).
A 26 mm self-expanding valve (Evolute R, Medtronic) was directly implanted but embolised, leading to mechanical obstruction of the left coronary artery. The valve was subsequently repositioned into the ascending aorta using snares and importantly …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Parental/guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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