Percutaneous transcatheter heart valve implantation in a bicuspid aortic valve.

ardio 77-year-old man presented with increasingly ymptomatic severe aortic stenosis (AS). Echocardioram showed an aortic valve area of 0.6 cm and a ean pressure gradient of 57 mm Hg. It could not be scertained conclusively if the valve was tricuspid or icuspid due to heavy calcification (Figs. 1A and 1B). ortic annulus was 20 mm in diameter. Left ventriclar ejection fraction was 40%. At cardiac catheterzation, calcified leaflets were seen but it could not be etermined if the valve was tricuspid on aortogram Figs. 2A and 2B). Cardiac computed tomography ngiography (CTA), however, conclusively revealed a tenosed bicuspid aortic valve (Figs. 3A to 3C). Due o prohibitive perioperative risk, the patient was eclined for surgery. Although bicuspid AS is a ontraindication in the ongoing PARTNER (Placeent of AoRTic TraNscathetER valves) trial, anecotal experience suggests that percutaneous valve