Slides

Transcatheter Aortic Valve Implantation with the Core Valve EVOLUT-R

- Operator : Seung-Jung Park

Transcatheter Aortic Valve Implantation with the Core Valve EVOLUT-R
- Operator: Seung-Jung Park, MD
Case Presentation
An 84 year-old gentleman was admitted with dyspnea on exertion. He has a past medical history of chronic obstructive pulmonary disease, hypertension and hyperlipidema. There was no significant stenosis on the coronary computed tomography angiography. Transthoracic echocardiography showed severe degenerative aortic valve (AV) stenosis with moderate LV systolic dysfunction (ejection fraction [EF) =38%). His logistic EuroSCORE was 10.48%. He declined recieving aortic valve replacement surgery.
Echocardiographic Findings
  1. Transthoracic echocardiography showed severe degenerative AV stenosis with moderate LV systolic dysfunction (EF=38%). AV area by continuity equation was 0.46 cm². Maximal transAV flow velocity was 6.3 m/s. Mean and peak pressure gradient were 107 and 158 mmHg, respectively.
  2. Transesophageal echocardiography showed the opening limitation of AV caused by heavy calcification and thickening. His AV was tricuspid and annulus size by TEE was 23 mm.
CT Findings
  1. Annulus size on CT was about 22 - 28 mm, and perimeter was 79 mm (Figure 1).
  2. Distance from annulus to LM and RCA ostium was 11 and 21 mm (Figure 2), respectively. The lowest diameter of right femoral artery was 9.9 mm(Figure 3).
Procedure
The annulus size by CT was 22 - 28 mm, perimeter was 79 mm. After discussion, we selected the 29 mm sized CoreValve EVOLUT-R. 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 both peripheral angiogram with pig-tail catheter, we checked proper a puncture site of right femoral artery. 8 Fr sheath was inserted through right femoral artery, and then two 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 straight-tip wire was used to cross the aortic valve. After crossing AV, the wire was replaced by a super-stiff wire. And then predilatation was done using a Z-MED II balloon 23 x 40 mm ( Movie 1), and 18 Fr CoreValve delivery catheter system (AccuTrak) was advanced gently into the vessel. The EVOLUT-R was crossed over AV using the super-stiff wire and deployment was done ( Movie 2). Final fluoroscopy showed well positioned CoreValve EVOLUT-R ( Movie 3). After the intervention, puncture site was sutured by prepared two Proglides.

Comments

  • oguz yavuzgil 2015-12-21 what do you think about the PVL? what was the the diastolic pressure?

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