Successful Treatment of Severe Paravalvular Leak by Repositioning a Self-Expandable Percutaneous Aortic Valve Bioprosthesis (Evolut PRO+) Using the “Double Snare” Technique

Figure 6

“Double snare” technique (fluoroscopy). (a) Low-lying Evolut PRO+ after initial implantation and postdilation (inset) with its inflow 2 cm below the aortic annulus (braces) for comparison. (b) Late ventricular valve migration and embolization into the left ventricle as the distance from the aortic annulus to the valve inflow worsened (3.0 cm) resulting in severe paravalvular leak. (c) The inner loop tab of the valve was snared first (arrow) via the right radial artery followed by the outer loop tab via the right femoral artery. Both snares were pulled to reposition the valve cranially. (d) After repositioning, the aortic annulus-to-valve inflow distance (braces, 1.3 cm) decreased and PVL improved.

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