Funnel-Shaped Expansion of Balloon-Expandable Transcatheter Aortic Valve Caused by Separated Tip of Expandable Sheath

An 86-year-old woman with a history of hypertension, atrial fibrillation, and lacunar cerebral infarction underwent transcatheter aortic valve implantation for symptomatic severe aortic stenosis using a 23-mm SAPIEN 3 Ultra RESILIA valve (Edwards Lifesciences). As the prosthetic valve traversed a 14-F Edwards eSheath+, it sheared off the distal tip of the sheath, which became affixed to the valve. The adherent tip remained attached throughout balloon expansion and deployment, thereby impeding full expansion and producing an atypical funnel-shaped configuration. With continued balloon inflation and sustained pressure, complete expansion was achieved, and the prosthetic valve was deployed without incident. TAKE-HOME MESSAGE: If the SAPIEN 3 Ultra RESILIA traverses the eSheath+ into the aorta with marked resistance, promptly confirm that the sheath's distal tip component has not remained affixed to the distal end of the prosthesis.