PMC9095411_01
Chart of Inovare  Alpha sizes.
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fig4
A 79-year-old female patient with 85 kg (body surface are = 2 cm2) had a rapid deployment aortic valve (Inovare  Alpha 22 mm; Braile Biomedica, Brazil) implanted 7 years ago (Figure 4).
As Inovare  Alpha is not present in the ViV App, we looked at the Perceval valve, which has a similar true ID. In a true ID of 17.5-19 mm, an Evolut R 23 mm is suggested.
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fig5
TAVR was indicated. The procedure was performed throughout percutaneous transfemoral access, and an Evolut R 23 mm THV (Medtronic, USA) was deployed using the balloon cracking technique to optimize the THV expansion and reduce final gradients (Figures 5-7).
ViV App suggestion of depth of implantation of an Evolut R 23 mm in a Perceval valve.
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fig6
TAVR was indicated. The procedure was performed throughout percutaneous transfemoral access, and an Evolut R 23 mm THV (Medtronic, USA) was deployed using the balloon cracking technique to optimize the THV expansion and reduce final gradients (Figures 5-7).
Step-by-step procedure. (a) Predilatation and valve cracking using an Atlas 20 mm noncompliant balloon while injecting contrast in the ascending aorta to simultaneously evaluate the left coronary artery flow. (b) Immediate prosthesis cracking and expansion with mean gradient reduction and PVL resolution. (c) Slow Evolut R 23 deployment immediately below the previously implanted rapid deployment valve. (d) Aortic regurgitation reduction on TEE and expansion of the previously implanted rapid deployment valve. (e) Final aortogram showing no aortic regurgitation and both prostheses proper expansion with a mean gradient of 8 mmHg.
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fig7
TAVR was indicated. The procedure was performed throughout percutaneous transfemoral access, and an Evolut R 23 mm THV (Medtronic, USA) was deployed using the balloon cracking technique to optimize the THV expansion and reduce final gradients (Figures 5-7).