Slides TCTAP
Transcatheter aortic valve implantation with the Core Valve
- Operator : Eberhard Grube
| Transcatheter aortic valve implantation with the Core Valve |
| - Operator: Eberhard Grube, MD |
| Case Presentation |
| An 86 year-old gentleman was admitted with dyspnea on exertion (NYHA class 2~3). He has a past medical history of diabetes, hypertension, and atrial fibrillation. His logistic EuroSCORE was 25.99%. His coronary angiogram was normal. |
| Echocardiographic findings |
| 1. Transthoracic echocardiography showed very severe degenerative AV stenosis and severe concentric LVH with normal LV systolic fuction (EF=64%). AV area by continuity equation was 0.55 cm². TransAV maximal velocity was 5.5 m/s. Mean and peak pressure gradient were 73 and 122 mmHg. Other findings were mild MR, mild AR, mild TR, and moderate pulmonary hypertension. 2. Transesophageal echocardiography showed the opening limitation of AV because of heavy calcification and thickening. His AV was tricuspid and annulus size by TEE was 21mm (Figure 1, Figure 2). |
| CT findings |
| 1. Annulus size was 21-22mm and perimeter was 80.5mm (Figure 3, Figure 4, Figure 5). 2. Distance from annulus to LM and RCA ostium was 16.2mm and 17.9mm, respectively (Figure 3, Figure 6). 3. Because the right lowest diameter was 7.6mm, there was enough to assess through right approach (Figure 7). |
| Procedure |
Although the annulus size by TEE and CT was 21mm, perimeter was 80.5mm. After discussion, we selected the larger sized CoreValve (29mm). 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. 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. The Core Valve crossed over AV using the super-stiff wire and deployment was done ( Movie 1, Movie 2). Final fluoroscopy showed well positioned CoreValve (Figure 8). After the intervention, puncture site was sutured by prepared three Proglides. |
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