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 71 year-old female presented with dyspnea on exertion (NYHA class III).She had history of hypertension, hyperlipidemia and stroke.Patient’s logistic Euroscore was 14%.
Echocardiographic Findings
  1. Transthoracic echocardiography showed severe degenerative AV stenosis and severe aortic regurgitation.But there was no regional wall motion abnormality and LV systolic dysfuction (EF=61%). Measured AV area by continuity equation was 0.66 cm². TransAV maximal velocity was 4.4 m/s. Mean and peak pressure gradient were 45 and 76 mmHg.Color Doppler showed vena contracta width above 6mm(Figure 1).
  2. Transesophageal echocardiography showed quadricusp aortic valve which had opening limitation and central coaptation defect. Also we could see severe AR filling two third of LVOT by TEE ( Movie 1, Movie 2). Measuredannulus size was 29mm(Figure 2).
CT Findings
  1. Annulus size was 24.2~27.9mm and perimeter was 82mm(Figure 3).
  2. Distance from annulus to LCA and RCA ostium was 10.2 and 10.5 mm, respectively.Both peripheral artery was enough to access (Figure 4, Figure 5).
Procedure
The aortic annulus size measured by TEE and CT was from 24.2mm to 29mm and perimeter measured by CT was 82mm. We selected29mm sized Core valve. After sedation, 6 Fr sheath and temporary pacemaker were inserted through left femoral vein and 7 Fr sheath and 6 Fr pig-tail catheters were inserted through left femoral artery. We found proper puncture site of right femoral artery by right peripheral angiogram using a pig-tail catheter. 8 Fr sheath was inserted through right femoral artery, and then three 8 Fr Proglide devices were placed into the right femoral artery. We removed Rt. Femoral artery sheath and exchanged to 18 Fr Ultimumsheath. An AL1 diagnostic catheter with a 0.035 inch Fixed core wire was used to cross the aortic valve.After crossing AV, we dilate the stenotic AV with a 23 mm x 40 mm Z-MED II balloon under rapid ventricular pacing and aortic root angiography ( Movie 3).As maintaining fluoroscopy view, 29mm Corevalvepassed the vessel throughCorevalve Delivery Catheter System.After placing at the best position of aortic annulus,the valvedeployedsuccessfully. We confirmedpatency of all coronary arteries and no paravalvular regurgitation by root angiography right after valve implantation ( Movie 4). We finished procedure with puncture site closure by prepared three Proglides.There was no rhythm disturbance, such as complete AV block, during hospitalization.

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