PMC9363569_01
Pre-procedural computed tomography assessment of aortic root. (A) Annular perimeter: 73.1 mm and annular area: 414.1 mm2. (B) Left-, right- and non-sinuses of Valsalva dimensions: 31.6 mm * 30.7 mm * 30.7 mm. (C) Average sinotubular junction diameter: 27.6 mm. (D,E) The height of coronary arteries: 11 mm (left) and 14.1 mm (right). (F) The distance from the edge of the calcified nodule to right coronary ostium: 23 mm.
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F1
Further anatomical measurements on MDCT included an annular perimeter of 73.1 mm, an annular area of 414.1 mm2, and the left main coronary artery (LMA) ostium height of 11 mm and right coronary artery (RCA) of 14.1 mm (Figures 1A,B,D,E). The dimensions of left-, right-, and non-coronary sinuses were 31.6, 30.7, and 30.7 mm, respectively (Figure 1B). The average dimension and the height of the sinotubular junction were 27.6 and 16 mm (Figure 1C). Measured on the plane of the right coronary ostium, the distance of the edge of the calcified nodule to right coronary ostium was 23 mm (Figure 1F).
Intraoperative fluoroscopy. (A) Fluoroscopy showed bilateral patent coronary arteries before balloon pre-dilatation. (B) The right coronary artery was invisible and reduced blood flow in the left coronary artery during the balloon dilatation. (C) Fluoroscopy showed the patency of bilateral coronary arteries after J-valve deployment.
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F2
At the beginning of the TAVR procedure, bilateral coronary arteries were patent under intraoperative fluoroscopy (Figure 2A). Unexpectedly, the right coronary artery was invisible and the blood flow reduced in the LMA, immediately after balloon dilatation (Figure 2B), indicating RCA completely occluded and LMA partially occluded by the native left coronary leaflet. The procedure was uneventful and the final fluoroscopy showed the proper position of the prosthetic valve and the patency of bilateral coronary arteries (Figure 2C).