# Valve-In-Valve TAVI in a Patient With Dextrocardia, Situs Inversus, and Challenging Commissural Alignment

## TL;DR

This paper describes a successful valve-in-valve TAVI procedure in a patient with rare heart anatomy, using specialized techniques to align the new valve correctly.

## Contribution

The paper introduces a novel strategy for commissural alignment during ViV-TAVI in patients with dextrocardia and situs inversus.

## Key findings

- Loading the Evolut FX+ C-tab 180° upside down in the delivery catheter facilitated commissural alignment.
- Adjusting the flush-port position to 5-o’clock enabled proper alignment of the TAVI valve with the former prosthesis.
- The former prosthetic valve commissure was oriented 60° from native commissures to preserve coronary access.

## Abstract

Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) for dextrocardia is challenging. An 81-year-old man with dextrocardia and situs inversus developed prosthetic aortic stenosis. Loading Evolut FX+ C-tab 180° upside down in a delivery catheter facilitates commissural alignment during ViV-TAVI in dextrocardia. To accommodate anatomical variations, the flush-port position can be adjusted. In this case, the flush port was positioned 5-o’clock (60° from the usual 3-o’clock position) to align the TAVI valve with former prosthesis, as the former prosthetic valve commissure was oriented 60° from native commissures to preserve coronary access for abnormal left coronary artery originating from native commissures. This case illustrates strategies for commissural alignment during ViV-TAVI in dextrocardia.