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Figure 1: (a) Right ventricular outflow tract angiogram shows a well-formed atretic pulmonary valve with a noncoaxial Judkins right coronary catheter (yellow arrow) lying away from pulmonary valve prohibiting safe movement of Conquest Pro coronary guidewire (red arrow). (b) Coronary microcatheter (green arrow) placed through the catheter bridges the gap between catheter tip and pulmonary valve. Radiopaque marker allowed positioning of microcatheter to the center of atretic pulmonary valve (c) Guidewire (red arrow), placed through microcatheter (yellow arrow), perforating the pulmonary valve. The movement of guidewire and microcatheter has pushed the catheter back in right ventricular outflow tract away from the pulmonary valve. (d) Echocardiogram shows guidewire across pulmonary valve through a central perforation with normal motion of pulmonary valve leaflets

Figure 1: (a) Right ventricular outflow tract angiogram shows a well-formed atretic pulmonary valve with a noncoaxial Judkins right coronary catheter (yellow arrow) lying away from pulmonary valve prohibiting safe movement of Conquest Pro coronary guidewire (red arrow). (b) Coronary microcatheter (green arrow) placed through the catheter bridges the gap between catheter tip and pulmonary valve. Radiopaque marker allowed positioning of microcatheter to the center of atretic pulmonary valve (c) Guidewire (red arrow), placed through microcatheter (yellow arrow), perforating the pulmonary valve. The movement of guidewire and microcatheter has pushed the catheter back in right ventricular outflow tract away from the pulmonary valve. (d) Echocardiogram shows guidewire across pulmonary valve through a central perforation with normal motion of pulmonary valve leaflets