ferase (U/L)       18              16                     13                                        15           0--32
  Alanine aminotransferase (U/L)         6                6                     5                                         5            0--33
  Gamma glutamyl transferase (U/L)       12               9                                                               9            0--40
  Alkaline phosphatase (U/L)             99                                     63                                        65          35--105
  Bilirubin (mg/dL)                     0.32                                                                             0.32          \<1.2
  NTproBNP (pg/mL)                      1302                                                                             580           \<300

The procedure was performed under general anaesthesia and guided by transoesophageal echocardiogram (TOE), via the right femoral route. Balloon valvuloplasty (20 × 40 mm balloon) was performed prior to aortic valve prosthesis implantation (Edwards Sapiens 3™, 23 mm, through a NovaFlex™ delivery system). Valvuloplasty and prosthesis deployment were accomplished during a burst of rapid ventricular pacing, using a temporary pacemaker, with 30--40 s of intentional low cardiac output state---systolic blood pressure (SBP) of 40--50 mmHg. After valve deployment, the patient presented a short period of hypotension (SBP 60--70 mmHg and diastolic blood pressure ±20 mmHg; heart rate ±100 b.p.m.), with spontaneous recovery in less than 3 min. The final result was satisfactory, with a slight leak in relation to the native left coronary cusp, a maximum transvalvular gradient of 12 mmHg, and a mean gradient of 5.3 mmHg. The patient was extubated at the end of the procedure and was admitted to the intensive care unit, with maintained haemodynamic stability and on spontaneous ventilation. Dual antiplatelet therapy (DAPT)---acetylsalicylic acid 100 mg and clopidogrel 75 mg---was initiat