[Transcatheter Aortic Valve Implantation Using a Balloon-expandable Valve in Small Size Surgical Aortic Valve for Structural Valve Deterioration].

We report a case of transcatheter aortic valve-in-surgical aortic valve( TAV in SAV) implantation for structural valve deterioration of a small bioprosthetic valve. An 81-year-old woman presented with heart failure 19 years after aortic valve replacement using a 19-mm bioprosthetic valve. Imaging studies revealed severe prosthetic valve stenosis. Considering high surgical risk and anatomic feature of misalignment between the axis of ascending aorta and bioprosthetic valve, balloon-expandable transcatheter heart valve implantation was successfully performed via femoral approach without complications. Postoperative echocardiography showed improved hemodynamic condition and the patient became less symptomatic. During TAV in SAV for small bioprosthetic valve, valve selection should be individualized based on anatomical and clinical characteristics.