Case Report: Patient-specific three-dimensional printing and computational fluid dynamics in the planning of transcatheter aortic valve replacement for quadricuspid aortic valve

Figures

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  Figure 1. Preoperative imaging assessments. (A,B) Preoperative echocardiography revealed quadricuspid aortic valve and severe regurgitation (regurgitant jet area measuring 9.8 cm2). (C–I) Preoperative computed tomography angiography accessment. (D) Sinus of Valsalva diameters 37.0–39.4 mm; (E) Annulus diameter: 26.0 mm; (F) Sinotubular junction diameter 34.4 mm; (G,H) Left and right coronary ostia heights 12.2 and 12.7 mm.

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  Figure 2. Preoperative patient-specific three-dimensional printing and computational fluid dynamics simulation. (A) Patient-specific three-dimensional printed aortic root model. (B, C) The preoperative simulation of implanting the 29-mm J-valve bioprosthesis valve. (D,E) Preoperative and postoperative computational fluid dynamics conceptual models. Red area indicates aortic valve; green area indicates bioprosthetic stent.

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  Figure 3. The change of pressure, velocity, and wall shear stress by procedural simulation. The trans-aortic valve pressure decreases from 4.7 mmHg to 3.5 mmHg; the velocity decrease from 1.02 m/s to 0.89 m/s; the low wall shear stress area increased from 18.92 cm2 to 19.15 cm2. WSS, wall shear stress.

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  Figure 4. The main steps of the procedure. (A) Fluoroscopy showed the position of aortic root. (B) The delivery system was advanced via the transapical approach. (C,D) The delivery system was advanced. (E,F) The stent was fully released, and fluoroscopy revealed that the bioprosthesis was in a stable position and functioning well with no paravalvular leak and coronary artery occlusion. (G,H) Echocardiography showed no regurgitation, and excellent leaflet mobility.