{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:47:41Z","timestamp":1791967661551,"version":"4.3.4"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) poses unique challenges. We report a case in which an apparently benign anatomy resulted in failure of conventional delivery strategies and required a novel balloon-assisted bailout technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 59-year-old man with a background history of liver cirrhosis presented with severe aortic stenosis due to type 1 BAV. The patient was in Child-Pugh class A with model for end-stage liver disease (MELD) score of 14; hence, he was planned for TAVI in view of high surgical risk. Pre-procedural computed tomography showed a favourable left ventricular (LV)-aortic angle, but the fused non-coronary and right-coronary cusp behaved like functional horizontal anatomy. Various previously described wire and balloon-assisted techniques failed to deliver the valve. A novel balloon-assisted modified \u2018shoe-horn\u2019 technique, by inflating a 16\u2005mm balloon in non-coronary sinus, altered the delivery trajectory and enabled successful valve delivery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>BAV with right non-coronary cusps fusion may behave like horizontal anatomy, despite favourable LV-aortic angle. A modified balloon-assisted shoe-horn technique can facilitate valve delivery when conventional methods fail. This case highlights an under-recognized mechanism of valve delivery failure in BAV and emphasizes the importance of preparedness for advanced bailout strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag616","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:50:54Z","timestamp":1787226654000},"source":"Crossref","is-referenced-by-count":0,"title":["Modified balloon-assisted shoehorn technique for transcatheter aortic valve implantation in functionally horizontal anatomy: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3795-9373","authenticated-orcid":false,"given":"Nilkanth","family":"Patil","sequence":"first","affiliation":[{"name":"Department of Cardiology, AIG Hospitals , Gachibowli, Hyderabad 500032 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