Ex vivo IVUS assessment of a 26-mm Evolut THV deployed in a severely calcified bicuspid aortic valve revealed severe inflow constraint (41.2% expansion) with preserved leaflet-level expansion.
Case Report (n=1)
Ex vivo IVUS assessment demonstrates that severe inflow constraint can coexist with preserved supra-annular leaflet-level expansion when a transcatheter heart valve is deployed in a severely calcified bicuspid aortic valve.
BACKGROUND: Transcatheter heart valve (THV) deployment in severely calcified bicuspid aortic valve (BAV) can result in complex frame deformation. Large field-of-view intravascular ultrasound (IVUS) offers a tomographic real-time assessment of this phenomenon. CASE SUMMARY: A 53-year-old male underwent surgery for severe calcific BAV stenosis. Ex vivo, a 26-mm Evolut THV was deployed inside the excised BAV specimen without balloon predilatation or postdilatation to preserve native calcified constraints. Automated IVUS pullback with a 10-MHz IVUS (Visions PV .035, Philips) over a 0.035-inch guidewire revealed severe inflow constraint (41.2% expansion) but preserved expansion at the leaflet nadir (107.6%) and coaptation (104.5%) levels. DISCUSSION: While recent clinical computed tomography studies report THV frame decoupling, real-time procedural imaging remains limited. This case provides direct mechanistic proof of how a rigid calcified raphe causes this segmental deformation. TAKE-HOME MESSAGES: IVUS demonstrated inflow-to-functional-frame decoupling. Severe inflow constraint may coexist with preserved supra-annular leaflet-level expansion.
Sadowski et al. (Mon,) conducted a case report in Severe calcific bicuspid aortic valve stenosis (n=1). Ex vivo deployment of a 26-mm Evolut THV with IVUS assessment was evaluated on THV frame expansion and deformation. Ex vivo IVUS assessment of a 26-mm Evolut THV deployed in a severely calcified bicuspid aortic valve revealed severe inflow constraint (41.2% expansion) with preserved leaflet-level expansion.