PMC8416351_01
(A) Pre-TAVR Cardiac Computed Tomography 3D volume rendered images demonstrating an anomalous Left Circumflex Artery and Minimal Intensity Projections denoting a course between the Left Atrium and Aorta. (B) Pre-TAVR Cardiac Computed Tomography images demonstrating an Aortic valve annulus of 3.86 cm 2 and Annulus to Left Main distance of 10 mm.
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F1
An echocardiogram revealed a trileaflet aortic valve (AV) that was severely stenotic and calcified with a maximum gradient of 100 mmHg, a mean gradient of 60 mmHg, an AV annulus diameter of 19 mm, an impaired left ventricular systolic function with an ejection fraction (EF) of 35%, and mildly dilated left ventricle with mild LVH (Supplementary Figure 1). CCT confirmed severe AS and revealed an anomalous LCX arising from the right coronary cusp, having a small caliber with diffuse disease (Figure 1A) and coursing between the aorta and left atrium. The AV annulus to the left main height was 0.98 cm, and the AV annulus area is 3.98 cm2 (Figure 1B).
Coronary angiogram demonstrated a patent RCA and LM artery ostia with some compression of the LCX's mid segment. As such the decision was to proceed as planned with a high implant of the Edwards Sapien 3 valve.
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F2
As such, the decision was to proceed as planned with a high implant of the Edwards SAPIEN valve (Figure 2). Post procedure, the gradient by echocardiography was 7 mmHg, and the EF had improved to 44.5% (Supplementary Figure 2).
Selective coronary angiography demonstrating widely patent coronary arteries including the anomalous LCX in two orthogonal views.
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F3
Selective angiography of the LCX with a 6-French AL 0.75 guiding catheter confirmed widely patent coronary arteries (Figure 3). A repeat CCT demonstrated thin leaflets with normal mobility and a widely patent LCX (Figure 4 and Supplementary Figure 3).
Post-TAVR Cardiac Computed Tomography images (Short and Long-axis) demonstrating thin mobile leaflets with no hypoattenuation.
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F4
A repeat CCT demonstrated thin leaflets with normal mobility and a widely patent LCX (Figure 4 and Supplementary Figure 3).