The patient with a history of dilated cardiomyopathy and severely reduced left ventricular (LV) function presented with severe heart failure. Transthoracic echo showed an LV ejection fraction of 21% and an LV thrombus (Panel A). Severe low-flow-low-gradient stenosis of a bicuspid aortic valve with a mean gradient of 22 mmHg and calculated aortic valve orifice area of 1.0 cm² (indexed orifice area 0.51 cm²) was diagnosed. The patient was initially treated with a biventricular ICD, without anticipated improvement. After heart-team discussion, it was decided to proceed with transcatheter aortic valve implantation (TAVI) due to high surgical risk and inability to wean from catecholamines. The multislice computer tomography showed a raphe type bicuspid valve (left + right cusp fusion) with a giant annulus (mean diameter 35.5 mm, perimeter 113.5 mm, and area 1007 mm²) and severe asymmetric calcification (Panels B and C).

中文翻译：

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1000 mm2加上主动脉瓣环：使用Sapien 3经导管心脏瓣膜成功治疗巨大的二尖瓣主动脉瓣膜。

有扩张型心肌病病史且左心室功能严重降低的患者表现为严重心力衰竭。经胸回声显示左心室射血分数为21％和左心室血栓（图A）。双尖瓣主动脉瓣的严重低流量低梯度狭窄，平均梯度为22 mmHg，计算出的主动脉瓣口面积为1.0 cm ²（标称孔口面积0.51 cm ²）被诊断。该患者最初接受双心室ICD治疗，但未见预期改善。经过心脏小组的讨论，由于手术风险高且无法从儿茶酚胺中撤出，因此决定继续进行经导管主动脉瓣植入术（TAVI）。多层计算机体层摄影术显示了一个缝环型双尖瓣（左+右尖瓣融合术），巨大的瓣环（平均直径35.5 mm，周长113.5 mm，面积1007 mm ²）和严重的不对称钙化（图B和C）。