TAVR With Patient-Specific Coronary Alignment for a Patient With an Anomalous Left Coronary Artery

BACKGROUND: An anomalous coronary artery is rare in patients undergoing transcatheter aortic valve replacement (TAVR). Achieving coronary alignment when performing TAVR can be challenging, but it is essential to preserve future coronary access and redo-TAVR options, particularly in younger patients with a longer life expectancy. CASE SUMMARY: A 62-year-old patient with severe, symptomatic bicuspid aortic stenosis and an anomalous left coronary artery underwent TAVR without complications. TAVR with coronary alignment was achieved by relying on patient-specific fluoroscopic projections and meticulous preprocedural cardiac computed tomography (CT) planning. DISCUSSION: An anomalous coronary anatomy can complicate TAVR planning and execution. Meticulous preprocedural planning based on cardiac CT is key in order to be successful and obtain patient-specific coronary alignment. TAKE-HOME MESSAGES: When treating younger patients with TAVR, identifying an anomalous coronary artery with an aberrant origin is important. TAVR with patient-specific coronary alignment in case of an anomalous coronary artery is feasible and requires meticulous preprocedural CT planning.