{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T08:00:47Z","timestamp":1767772847228,"version":"3.37.3"},"reference-count":6,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2014,2,12]],"date-time":"2014-02-12T00:00:00Z","timestamp":1392163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:p>We report a case of valve\u2010in\u2010valve (ViV) implantation by transfemoral approach with a 23\u2010mm balloon\u2010expandable prosthesis inside a stentless 19\u2010mm acutely degenerated bioprosthesis, using a strategy of \u201cextreme\u201d underfilling. A 74\u2010year\u2010old patient presented to our institution in cardiogenic shock. An initial transesophageal echocardiography (TEE) showed severe central aortic regurgitation (AR) due to a torn leaflet. She was deemed inoperable and considered for urgent transcatheter aortic valve replacement. Given the fairly small true internal diameter, a strategy of 3\u2010cc underfilling of a 23\u2010mm transcatheter heart valve (THV) was planned. However, the final implantation was performed with 5\u2010cc underfilling due to the incapacity to deliver the entire amount of fluid contained in the inflation syringe. TEE guidance confirmed the successful positioning and deployment of the prosthesis, with no AR and a mean gradient of 25 mm Hg. While implantation of a smaller prosthesis (20 mm) was debated during the Heart Team discussion, the risk of valve embolization due to inadequate anchoring inside the stentless prosthesis led to the selection of a 23\u2010mm THV. At 6\u2010month follow\u2010up, the patient was in NYHA class I, with no AR and a mean gradient of 28 mm Hg. We report for the first time the use of in vivo THV with 5\u2010cc underfilling with no acute or short\u2010term structural failure, and the first ViV implantation by transfemoral approach with a 23\u2010mm balloon\u2010expandable prosthesis inside a stentless 19\u2010mm bioprosthesis. The current report presents the challenges related to ViV implantation inside a small stentless bioprosthesis and offers practical ways to overcome them. \u00a9 2014 Wiley Periodicals, Inc.<\/jats:p>","DOI":"10.1002\/ccd.25381","type":"journal-article","created":{"date-parts":[[2014,1,9]],"date-time":"2014-01-09T02:08:49Z","timestamp":1389233329000},"page":"503-508","source":"Crossref","is-referenced-by-count":9,"title":["Valve\u2010in\u2010valve implantation with a 23\u2010mm balloon\u2010expandable transcatheter heart valve for the treatment of a 19\u2010mm stentless bioprosthesis severe aortic regurgitation using a strategy of \u201cextreme\u201d underfilling"],"prefix":"10.1002","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1892-8427","authenticated-orcid":false,"given":"Florent","family":"Chevalier","sequence":"first","affiliation":[{"name":"H\u00f4pital du Sacr\u00e9\u2010Coeur de Montr\u00e9al Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathon","family":"Leipsic","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging and Medicine St Paul's Hospital, University of British Columbia Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"G\u00e9n\u00e9reux","sequence":"additional","affiliation":[{"name":"H\u00f4pital du Sacr\u00e9\u2010Coeur de Montr\u00e9al Montr\u00e9al Qu\u00e9bec Canada"},{"name":"Columbia University Medical Center and the Cardiovascular Research Foundation New York New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,2,12]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_5_2_1","DOI":"10.1161\/CIRCULATIONAHA.112.104505"},{"doi-asserted-by":"publisher","key":"e_1_2_5_3_1","DOI":"10.1016\/j.jcin.2011.09.006"},{"doi-asserted-by":"publisher","key":"e_1_2_5_4_1","DOI":"10.1016\/j.jtcvs.2012.07.104"},{"doi-asserted-by":"publisher","key":"e_1_2_5_5_1","DOI":"10.1002\/ccd.23198"},{"doi-asserted-by":"publisher","key":"e_1_2_5_6_1","DOI":"10.1161\/CIRCULATIONAHA.113.002947"},{"key":"e_1_2_5_7_1","article-title":"Underexpansion and ad hoc post\u2010dilation in selected patients undergoing balloon\u2010expandable transcatheter aortic valve replacement","author":"Barbanti M","year":"2013","journal-title":"J Am Coll Cardiol"}],"container-title":["Catheterization and Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fccd.25381","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccd.25381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T15:55:54Z","timestamp":1696607754000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccd.25381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2,12]]},"references-count":6,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2014,9]]}},"alternative-id":["10.1002\/ccd.25381"],"URL":"https:\/\/doi.org\/10.1002\/ccd.25381","archive":["Portico"],"relation":{},"ISSN":["1522-1946","1522-726X"],"issn-type":[{"type":"print","value":"1522-1946"},{"type":"electronic","value":"1522-726X"}],"subject":[],"published":{"date-parts":[[2014,2,12]]}}}