Slides

Transcatheter Aortic Valve Implantation with the Core Valve

- Operator : Seung-Jung Park

Transcatheter Aortic Valve Implantation with the Core Valve
- Operator: Seung-Jung Park, MD
Case Presentation
A 73 years-old gentleman was admitted with dyspnea on exertion (NYHA class III). He has a past medical history of hypertension, and hyperlipidemia. His logistic EuroSCORE was 6.41%. His coronary angiography showed narrowing of distal LAD, and proximal LCX, of which diameter stenosis were 60%, and 50%, respectively. First, we recommended open heart surgery but patient refused.
Echocardiographic Findings
  1. Transthoracic echocardiography showed severe degenerative AS, moderate AR, and concentric LVH with normal LV systolic function (EF=58%). AV area by continuity equation was 0.7 cm². TransAV maximal velocity was 5.6 m/s. Peak and mean pressure gradient were 125 and 77 mmHg.
CT Findings
  1. Annulus size by CT was 22.9 - 31.0 mm and perimeter was 86.1 mm and Annulus area was 546 mm2 (Figure 1).
  2. 2. Distance from annulus to LM and RCA ostium was 17.1 and 14.4 mm, respectively. The lowest diameter of right femoral artery was 8.1 mm and there was no problem in vessel size and calcification (Figure 2, Figure 3, Figure 4).
Procedure
The annulus size by CT was 22.9 - 31.0 mm and perimeter was 86.1 mm. After discussion, we selected the 31 mm CoreValve for implantation. Under general anesthesia, 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, we checked proper puncture site of right femoral artery. 8 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. An AL 1 diagnostic catheter with a 0.035 inch stiff wire was used to cross the aortic valve. After crossing AV, the stiff wire was replaced by a 0.035 inch Lunderquist super-stiff wire, and then predilatation of the stenotic AV was undertaken with a Z-MED II balloon 23mm x 4cm under rapid ventricular pacing and aortic root angiography ( Movie 1). The 18 Fr CoreValve delivery catheter system (AccuTrak) was advanced gently into the vessel. The Core Valve crossed over AV using the super-stiff wire and deployment was done. Immediately after valve implantation, root angiography showed all coronary arteries was patent and minimal paravavular regurgitation ( Movie 2, Movie 3). Final fluoroscopy showed well positioned CoreValve ( Movie 4, Movie 5). After the intervention, puncture site was sutured by prepared three Proglides.

Comments

Leave a comment

Sign in to leave a comment.