Trans-catheter aortic valve implantation is rapidly becoming an established modality of treatment for patients with critical aortic stenosis who are high risk for conventional aortic valve replacement. This approach also has its limitations; however, with growing experience and improvements in the delivery system, it may be possible to overcome these limitations. We describe a case where conventional trans-catheter approaches, that is, transfemoral or trans-apical using the Edwards THV system, were not possible but successful implantation was achieved through the trans-aortic route.
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