PMC6828560_01
Preinterventional multisclice computed tomography. Preprocedural planning of transcatheter aortic valve implantation with echocardiogram-gated multislice computed tomography in severe aortic regurgitation of a native aortic valve in a patient with left ventricular assist device: diameter, perimeter, and area of the annulus (
A
), depiction of nonexistent calcifications in hockey-puck view (
B
), sinus diameters (
C
), and aortic arch with angle of aortic root for subsequent deployment of transcatheter heart valve (
D
).
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AR with volume overload left ventricular dilatation. Morphologically, the aortic valve was tricuspid and free of any calcification ( Fig. 1A,B ). AR was eccentric caused by retraction of the noncoronary cusp. Preprocedural echocardiogram-gated multislice computed-tomography (MSCT) demonstrated an effective perimeter-derived annulus diameter of 22.4 mm, annulus perimeter of 70.5 mm, and area of 390.3 mm 2 ( Fig. 1 ). Coronary distances from the aortic plane were 14.9 mm (right) and 11.4 mm (left), sinus diameters were 26.2 mm/27.9 mm/27.8 mm for non-/left-/right-coronary sinuses ( Fig. 1 ).
Intraprocedural fluoroscopy images. Fluoroscopy of transcatheter aortic valve implantation in severe aortic regurgitation of a native aortic valve in a patient with left ventricular assist device: root shot with depiction of severe aortic regurgitation (
A
), placement of a self-expandable transcatheter heart valve with alignment of radiopaque markers slightly above the height of the aortic annulus (
B
), transcatheter heart valve after final deployment (
C
) and final root shot with no residual aortic regurgitation, and left ventricular assist device at the left ventricular apex (
D
).
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Boston Scientific Corp., Marlborough, Massachusetts, United States) was inserted and placed carefully in a para-apical position immediately adjacent to the LVAD inflow cannula. By the guidance of TEE and fluoroscopy and using a single diagnostic noncoronary cusp pigtail catheter, the THV was inserted via an 18Fr Boston iSleeve sheath and advanced to an intra-annular position with the annular marker band slightly above the native aortic valve annulus ( Fig. 2 ). THV stent expansion ( Fig. 2 ), complete absence of paravalvular leakage (PVL), and a transprosthetic gradient of peak/mean 4/1 mm Hg. Throughout the procedure, completely stable hemodynamics were noted with low doses of catecholamines. 