PMC10117784_01
Transesophageal echocardiographic long access view of the aortic valve showing aortic regurgitation jet (yellow arrow).
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F1
Echocardiography demonstrated a very low left ventricular ejection fraction (LVEF) of 23%, dilated left ventricle with end-diastolic volume of 424 ml and an elevated left ventricular end-diastolic diameter (LVEDD) of 8.7 cm, severe mitral regurgitation (MR), and mild to moderate eccentric AI (Figure 1). MSCT analysis revealed, the aortic annulus area was 702.1 mm2, area-derived annular diameter was 29.9 mm, annular perimeter was 96.5 mm, and the right and left coronary artery heights were 15.4 and 13.3 mm, respectively (Supplementary Figures S1 and S2).
(A) Native annulus stitching with 2/0 Ethibond sutures (green arrow). (B) Carbomedics Annuloflex flexible ring #32 stitching (green arrow). (C) Carbomedics Annuloflex ring #32 positioning and fixation (green arrow).
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F2
MSCT analysis revealed, the aortic annulus area was 702.1 mm2, area-derived annular diameter was 29.9 mm, annular perimeter was 96.5 mm, and the right and left coronary artery heights were 15.4 and 13.3 mm, respectively (Supplementary Figures S1 and S2). AV leaflets was sewn using an Ethibond 2/0 suture (Johnson & Johnson Medical N.V., Belgium) to the ventricular myocardium (Valvar Hinge) using three stitches, each leaflet bearing one stitch. A flexible annuloplasty ring [CARBOMEDICS AnnuloFlex TM32 flexible ring (Sorin Group Italia S.r.L., Italy)] was fixed with the native annulus using the same stitches to provide a sturdy base for valve replacement, as illustrated in Supplementary Figure S3 and in Figure 2.
(A) Deployment of the 30.5 mm Myval THV (green arrow) positioning into the ring (yellow arrow). (B) Deployed THV (green arrow). THV, transcatheter heart valve.
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F3
AV leaflets was sewn using an Ethibond 2/0 suture (Johnson & Johnson Medical N.V., Belgium) to the ventricular myocardium (Valvar Hinge) using three stitches, each leaflet bearing one stitch. A flexible annuloplasty ring [CARBOMEDICS AnnuloFlex TM32 flexible ring (Sorin Group Italia S.r.L., Italy)] was fixed with the native annulus using the same stitches to provide a sturdy base for valve replacement, as illustrated in Supplementary Figure S3 and in Figure 2. System filled with a nominal volume of 36 ml saline, as shown in Figure 3.
Implantation of HeartMate 3  LVAD, LVAD HM3 outflow graft (green arrow), and LVAD HM3 driveline cable (yellow arrow). LVAD, left ventricular assist device.
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F4
Postoperative echocardiography and fluoroscopy results confirmed the adequate valve positioning without any transvalvular or periprosthetic regurgitation, as shown in Supplementary Figure S4.