Slides
Transcatheter Aortic Valve Implantation with the CoreValve
- Operator : Seung-Jung Park
| Transcatheter Aortic Valve Implantation with the CoreValve |
| - Operator: Seung-Jung Park, MD |
| Case Presentation |
| An 80 year-old female was admitted with dyspnea on exertion (NYHA class III). She has a past medical history of hypertension and hypothyroidism. Her logistic EuroSCORE was 11.59%. Firstly, we recommended the operation to her. However, she refused open heart surgery. After discussion with her and her family, we decided to perform the CoreValve TAVI. Her coronary angiogram showed mild stenosis at mLAD. |
| Echocardiographic findings |
| 1. Transthoracic echocardiography showed very severe degenerative AV stenosis and global LV hypokinesia with moderate LV dysfuction (EF=40%). AV area by continuity equation was 0.65 cm². TransAV maximal velocity was 4.4 m/s. Mean and peak pressure gradient were 46 and 76 mmHg. 2. Transesophageal echocardiography showed the opening limitation of AV because of heavy calcification and thickening. Her AV was tricuspid and annulus size by TEE was 22mm ((Figure 1). |
| CT findings |
| 1. Annulus size by CT was 21-22mm (Figure 2, Figure 3). 2. Distance from annulus to LM and RCA ostium was 16.9 and 12.5 mm, respectively (Figure 4, Figure 5). The right lowest diameter was 7.5mm and there was no problem to approach through right peripheral artery (Figure 6). |
| Procedure |
Because the annulus size by TEE and CT was 21-22mm, we selected the 26mm CoreValve. 6 Fr sheath and temporary pacemaker were inserted through left femoral vein, and 7 Fr sheath and 6 Fr pig-tail catheter were inserted through left femoral artery. After right peripheral angiogram with pig-tail catheter ( Movie 1), we checked proper puncture site of right femoral artery. 7 Fr sheath was inserted through right femoral artery, and then three 8 Fr Proglide devices were placed into the right femoral artery. After removal of the sheath, 18 Fr Ultimum sheath was placed. And then, an AL 1 diagnostic catheter with a stiff wire was used to cross the aortic valve. After crossing AV, the stiff wire was replaced by a super-stiff wire, and then the 18 Fr CoreValve delivery catheter system (AccuTrak) was advanced gently into the vessel ( Movie 2). The Core Valve crossed over AV using the super-stiff wire and deployment was done ( Movie 3). Final fluoroscopy showed well positioned CoreValve ( Movie 4). After the intervention, puncture site was sutured by prepared three Proglides. |
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