The incidental finding of a severe occlusive disease of the aorta (coral reef aorta) during the assessment for transcatheter aortic valve replacement in a 75-year-old woman with severe aortic stenosis complicated the process for the Heart Team and led to the consideration of a different access route to find the safest and most appropriate strategy of intervention. A successful transapical transcatheter aortic valve replacement was eventually performed. Coral reef aorta, although rare, is associated with great morbidity and mortality, and it needs to be recognized when planning for intravascular procedures, both for a safer selection of treatment approach and for the prevention of intraprocedural and postprocedural morbidities.
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