Transcatheter Aortic Valve Implantation with Edwards SAPIEN XT Valve

- Operator : Seung-Jung Park

Transcatheter Aortic Valve Implantation with Edwards SAPIEN XT Valve
- Operator: Seung-Jung Park, MD
Case Presentation
A 82 years-old man was admitted with dyspnea on exertion (NYHA class III). He had past medical history of hypertension and diabetes. His logistic EuroSCORE was 6.61% and coronary angiography was normal.
Echocardiographic Findings
Transthoracic echocardiography showed severe degenerative AS with concentric LVH. LV systolic function (EF=61%) was normal without regional wall motion abnormality. AV area by continuity equation was 0.74 cm©÷. TransAV maximal velocity was 5.0 m/s. Peak and mean pressure gradient were 101 and 57 mmHg.
CT Findings
  1. Annulus size by CT was 21.9-30.3mm and perimeter was 82.5mm (Figure 1).
  2. Distance from annulus to LM and RCA ostium was 13.9 and 18.2 mm, respectively (Figure 2).
  3. The lowest diameter of left femoral artery was 7.4 mm and there was no problem in vessel size and calcification (Figure 3).
Procedure
The annulus size by CT was 21.9-30.3mm, perimeter was 82.5mm. After discussion, we selected the 29mm Edwards SAPIEN XT valve for implantation. Under general anesthesia, 6Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7Fr sheath and 6Fr 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. 8Fr sheath was inserted through right femoral artery, and then three 8Fr Proglide devices were placed into the right femoral artery. After removal of the sheath, 18Fr Edwards E-sheath was inserted. An AL2 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 0.035-inch Lunderquist super-stiff wire, and then predilatation of the stenotic AV was undertaken with a 26x40mm Edwards transfemoral balloon up to 23mm under rapid ventricular pacing and aortic root angiography ( Movie 1). Under fluoroscopy control, a 29mm Edwards SAPIEN XT prosthesis crimped on the delivery catheter (NovaFlex Delivery System) was placed at the best position of the aortic annulus and then it was successfully deployed by inflating the balloon up to 28mm under rapid ventricular pacing and aortic root angiography ( Movie 2). Final fluoroscopy showed well positioned Edwards Valve ( Movie 3). After the removal of Edward 18 Fr sheath, we checked the right peripheral angiogram and the puncture site was sutured by prepared three Proglides.

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