Transcatheter Aortic Valve Replacement for Patients With Aortic Valve Stenosis Complicated With Moyamoya Disease Koichi Maeda, MD, Toru Kuratani, MD,

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Transcatheter Aortic Valve Replacement for Patients With Aortic Valve Stenosis Complicated With Moyamoya Disease Koichi Maeda, MD, Toru Kuratani, MD, Kei Torikai, MD, Isamu Mizote, MD, Takeshi Iritakenishi, MD, Yasuharu Takeda, MD, Satoshi Nakatani, MD, Shinsuke Nanto, MD, Koichi Toda, MD, Yoshiki Sawa, MD The Annals of Thoracic Surgery Volume 98, Issue 4, Pages 1443-1445 (October 2014) DOI: 10.1016/j.athoracsur.2013.10.064 Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Magnetic resonance angiograms showing (A, B) moyamoya vessels (arrows) and (A) bilateral occluded internal carotid arteries in the supraclinoid portion (arrowheads). The Annals of Thoracic Surgery 2014 98, 1443-1445DOI: (10.1016/j.athoracsur.2013.10.064) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Positron emission tomography—computed tomography using diamox showing (A) a severe decrease in cerebral blood flow in the bilateral anterior and middle cerebral arteries with patient at rest and (B) a significant high risk of hemodynamic cerebral ischemia in these areas after diamox load. The Annals of Thoracic Surgery 2014 98, 1443-1445DOI: (10.1016/j.athoracsur.2013.10.064) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Preoperative electrocardiogram-gated, multislice computed tomographic image showing that the right coronary cusp may be obstructing the orifice of the right coronary (predicted movement [arrow] and position [broken line] of the native valve after prosthetic valve implantation). The Annals of Thoracic Surgery 2014 98, 1443-1445DOI: (10.1016/j.athoracsur.2013.10.064) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Two bare-metal stents implanted in the orifice of the right coronary artery after prosthetic valve implantation. (IC = inflow cannula of cardiopulmonary bypass; MW = micro-wire.) The Annals of Thoracic Surgery 2014 98, 1443-1445DOI: (10.1016/j.athoracsur.2013.10.064) Copyright © 2014 The Society of Thoracic Surgeons Terms and Conditions