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 |
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CT Findings |
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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. |
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