Management of a Chronically Infolded Self-Expanding Aortic Valve

Figures

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  Figure 1. Pre-TAVR CT Angiography Pre-TAVR CT scan demonstrates valvular calcification (A) and annular dimensions (B). CT = computed tomography; TAVR = transcatheter aortic valve replacement.

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  Figure 2. Left Ventricular Dimensions Over Time by Echocardiography Temporal trend in ejection fraction (EF), left ventricular end-diastolic volume (EDV), and end-systolic volume (ESV), estimated using the modified Simpson's method on transthoracic echocardiography. ViV = valve-in-valve; TAVR = transcatheter aortic valve replacement.

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  Figure 3. Echocardiographic Doppler of the Infolded Self-Expanding Aortic Prosthesis Transesophageal echocardiography revealed severe aortic insufficiency and deformation of the transcatheter aortic valve replacement (arrow).

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  Figure 4. Fluoroscopic Projection of Infolded Prosthesis Fluoroscopy at the time of valve deployment demonstrates infolding along the bottom half of the valve (arrow).

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  Figure 5. 3D CT Projection of Infolded Prosthesis Reconstruction of computed tomography angiography imaging revealed a focal kink across the commissure of the the left and noncoronary cusps.

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  Figure 6. Valvuloplasty and Valve-in-Valve TAVR Balloon dilation (A) resolved the infolding of the Evolut valve, but TEE showed persistent perivalvular regurgitation (B). Valve-in-valve TAVR was performed with a Sapien 3 Ultra valve (C), which resulted in resolution of the regurgitation (D). TAVR = transcatheter aortic valve replacement; TEE = transesophageal echocardiography.