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As reported by the field clinical specialist (fcs), approximately 1 year and 8 months post transcatheter valve replacement procedure with a 29mm sapien 3 valve, the valve failed due to moderate-to-severe paravalvular leak (pvl) at the left cusp, as detected by transesophageal echocardiogram (tee).The physician requested an edwards representative be present for a re-dilation.The first dilation was a nominally prepped 29mm commander delivery system, and the pvl improved to moderate.After discussing with the operating team, the decision was made to add an additional 1ml to the balloon and post dilate again, but with concern for annular rupture.The post-dilation was performed successfully and the pvl had reduced to mild per tee.At this point, the team decided that they would stop rather than risk a rupture, considering the patient's age and calcium burden.It was noted that the patient had a known enlarged root previously and calcium at the left cusp, extending into the left ventricular outflow tract (lvot).Also, the pvl was present at initial implant and was trace at that time.
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