PMC10192622_01
Trans-esophageal echocardiography in TAVR procedure. (A, B) Continuous Doppler showing the peak transvalvular pressure gradient: pre and post TAVR; (C) Postoperative echocardiography showed the prosthetic aortic valve with good morphology; (D) Postoperative echocardiography showed no significant aortic regurgitation after TAVR. LA, left atrium; RA, right atrium; LV, left ventricle; RVOT, right ventricular outflow tract; AO, aorta.
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F1
Electrocardiography (EKG) demonstrated a sinus rhythm of 80 beats per minute, a normal axis, and left ventricular hypertrophy. Echocardiogram showed severe aortic stenosis (aortic valve area, 0.2 cm2; mean pressure gradient, 78 mmHg; peak velocity, 5.8 m/s) and a reduced left ventricular ejection fraction of 35% (Figure 1A). The aortic transvalvular pressure difference decreased from 100mmHg pre-TAVR to 18 mmHg post-TAVR (Figures 1B, 3B). Trans-esophageal echocardiography (TEE) revealed no significant aortic regurgitation and auscultation indicated a markedly reduced murmur (Figures 1C, D; Supplementary Video S1).
Ct aortogram and invasive aortic angiography. (A, B) CTA showed severe calcified bicuspid aortic valve stenosis (type 0) and stenotic calcified eccentric aortic coarctation 20 mm distal to the left subclavian artery; (C)A CP stent was implanted via the right femoral artery; (D) Aortic valve balloon dilatation via the left carotid artery (arrow: 20F sheath); (E) Prosthetic valve was implanted; (F) CT follow-up revealed both devices were properly positioned.
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F2
Severe asymmetric diffuse leaflet calcifications were observed in bicuspid aortic valve (BAV) type 0, as well as marked calcifications of the ascending aorta and aortic arch (Figures 2A,B). Firstly, we implanted a 45 mm enlarged Cheatham-Platinum (CP) stent installed on a 22*45 mm BIB (balloon in balloon) catheter via the right femoral access, immediately distal to the LSA (Figure 2C), and achieved complete pressure gradient resolution across the CoA (from 35 mmHg to 3 mmHg) (Figure 3A). The findings revealed that there was no obvious balloon lumbar sign and aortic regurgitation, and that the left and right coronary arteries were well-developed (Figure 2D). Due to the concise and direct approach, the feedback of delivery manipulation is excellent, and the final valve deployment was in the optimal position (Figure 2E). A radiological follow-up revealed that both devices were correctly positioned (Figure 2F).
Pressure gradient variation. (A) Pre and post CoA interventional procedure; (B) Pre and post TAVR.
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F3
Firstly, we implanted a 45 mm enlarged Cheatham-Platinum (CP) stent installed on a 22*45 mm BIB (balloon in balloon) catheter via the right femoral access, immediately distal to the LSA (Figure 2C), and achieved complete pressure gradient resolution across the CoA (from 35 mmHg to 3 mmHg) (Figure 3A). The aortic transvalvular pressure difference decreased from 100mmHg pre-TAVR to 18 mmHg post-TAVR (Figures 1B, 3B).