Slides
Transcatheter Aortic Valve Implantation with the Core Valve
- Operator : Seung-Jung Park
| Transcatheter Aortic Valve Implantation with the Core Valve |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| A 85 year-old gentleman was admitted for dyspnea on exertion (NYHA class III-IV). He has a past medical history of hypertension, and hyperlipideima. His logistic EuroSCORE was 25.69 %. His coronary angiogram showed normal. |
| Echocardiographic Findings |
| 1. Transthoracic echocardiography showed severe degenerative AV stenosis and severe concentric LVH with normal LV systolic function (EF=64%). AV area by continuity equation was 0.66 cm². TransAV maximal velocity was 5.2 m/s. Mean and peak pressure gradient were 62 and 104 mmHg. 2. Transesophageal echocardiography showed the opening limitation of AV because of heavy calcification and thickening. His AV was bicuspid and annulus size by TEE was 27 mm (Figure 1). |
| CT Findings |
| 1. Annulus size by CT was about 22.8 ~ 25.1 mm, and perimeter was 86 mm (Figure 2, Figure 3, Figure 4). 2. Distance from annulus to LM and RCA ostium was 14.9 and 14.5 mm, respectively. The lowest diameter of right femoral artery was 8.8 mm and there was no problem in vessel size (Figure 5, Figure 6, Figure 7). |
| Procedure |
The annulus size by CT was 22.8 ~ 25.1 mm, perimeter was 86 mm. After discussion, we selected the 31 mm sized CoreValve. 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7 Fr sheath and 6 Fr pig-tail catheter were inserted through left femoral artery. After right peripheral angiogram with pig-tail catheter, we checked proper puncture site of right femoral artery. 7 Fr sheath was inserted through right femoral artery, and then three 8 Fr Proglide devices were placed into the right femoral artery. After removal of the sheath, 18 Fr Ultimum sheath was placed. And then, an AL 1 diagnostic catheter with a 0.035 inch stiff wire was used to cross the aortic valve. After crossing AV, the stiff wire was replaced by a super-stiff wire. And then predilatation was done using a Z-MED II balloon 22 x 40 mm ( Movie 1), and 18 Fr CoreValve delivery catheter system (AccuTrak) was advanced gently into the vessel. The Core Valve crossed over AV using the super-stiff wire and deployment was done ( Movie 2). Final fluoroscopy and supra aortic angiogram showed well positioned CoreValve and postdilatation was not required ( Movie 3). After the intervention, puncture site was sutured by prepared three Proglides. |
Leave a comment
Sign in to leave a comment.
Comments