Patient A, 82 years old.Complaints: shortness of breath arisingfrom physical exertion, resolving spontaneously at rest.Medical history: Hypertension since 2002,heart defect diagnosed in 2016, atherosclerosis.Life history: unremarkableDiagnosis: I35.2 Sclerotic combined aorticheart defect, with predominant stenosis.Complication of the underlying disease: CHF 2A,FC 3. Paroxysmal atrial fibrillation.Associated diseases: Hypertension stage 3, degree of hypertensioncorrected, risk 4.

Echocardiography: EF 63%. Aortic valve FR- 2.1 cm, leaflets are compacted, Ca 3 stage, mobility is limited GD 141/100 mmHg GD of the outflow tract- 3/2 Vmax- 594 cm/s AVA (VTI)- 0.4 cm2. Mitral valve leaflets are compacted, Ca of the fibrous ring, mobile. GD 7/3 mmHg GD 4.0 mmHg. There is no pericardial effusion. Dopplerography: Mitral regurgitation 2 (+) VC- 0.41 cm Aortic regurgitation 1 (+) Tricuspid regurgitation 2-3 (+). VC- 0.3 cm Calculated pressure in the right ventricle 44 mmHg.

The aortic valve opened stepwise under X-ray control and with contrast from an automatic injector. The valve delivery system folded and removed stepwise. Control performed using transthoracic echocardiography and contrast from a C Pig 6Fr 125 cm catheter.Control images show dislocation of the aortic prosthesis in the ascending aorta, a decision was made to convert the access and determine further tactics of surgical intervention intraoperatively in the cardiac surgery operating room.

Sternotomy. Pericardiotomy. During revision, the heart is enlargedmainly due to the left sections, the ascending aorta is not dilated. Theprosthesis frame palpated in the ascending aorta up to the brachiocephalictrunk. Cannulation of the aorta into the arch. Connection of the artificialheart pump according to the scheme - "Aorta-Right atrium" using atwo-stage venous cannula. Longitudinal aortotomy. The prosthesis is in thelumen of the aorta. The prosthesis carefully removed. Clamp on the aorta. The prosthesis immersed in ice. Antegrade cardioplegia into the orificesof the coronary arteries. Drainage of the left sections of the heart - theorifice of the right superior pulmonary vein. Asystole. During revision: theaortic valve is tricuspid with pronounced calcification of the valves.Marginal decalcification of the left and right coronary cusps. Theprosthesis frame has become flexible, the folded prosthesis is implanted intothe aortic ring.The prosthesis arches fixed to the ring and to the aorta on Teflongaskets on three sides. The prosthesis cusps function normally.

1. Stay brave and curious.2. Noone is immune from complications during surgery, and you always need to beprepared for them.3. Endovascular surgery always occurs in closecooperation with related specialties, in this case with cardiovascular surgery.This allows us to solve all the difficulties that arise in the best possibleway for the patient.