Matias B. Yudi et al. JACC 2018;71:

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Matias B. Yudi et al. JACC 2018;71:1360-1378 Valve-in-Valve TAVR and Coronary Artery Relationships Small sinotubular junction and short sinus height in the presence of a surgical bioprosthesis predicts high coronary obstruction risk with valve-in-valve TAVR (A). The dashed lines depict the position of the bioprosthetic valve leaflets (virtual valve) after valve-in-valve TAVR, and the red circle shows near obliteration of the space necessary for coronary perfusion. After implantation of a repositionable self-expanding valve, coronary perfusion remained adequate (white arrow), likely due to its self-expanding nature preventing overexpansion of the transcatheter valve frame toward the sinotubular junction (B). TAVR = transcatheter aortic valve replacement. Matias B. Yudi et al. JACC 2018;71:1360-1378 2018 American College of Cardiology Foundation