Coronary protection for the small left coronary sinus during transcatheter aortic valve replacement: a case report

BACKGROUND: Coronary obstruction (CO) is an infrequent but life-threatening complication during transcatheter aortic valve replacement (TAVR). CASE SUMMARY: We report the case of a patient who accepted TAVR with high anatomical risks of CO due to the small congenital left coronary sinus, which was treated with preliminary coronary protection. This case highlighted the importance of computed tomography angiography (CTA) evaluation, 3D-printing stimulation, predilation as a reference sign, and pre-emptive chimney stenting technology to successfully anticipate and prevent CO during TAVR. At the 3rd month follow-up, CTA evaluation and 3D-printing simulation identified the chimney stenting of the left main coronary arterial patency. DISCUSSION: A ‘four-step assessment’ method also proposes a new clinical procedure on how to perform TAVR in patients with high risks of CO.