What Do I Do if the Valve Don't Pass? Use a Snare Catheter!

Figures

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  FIGURE 1. Measurement of the aortic ring size and prosthesis selection based on the pre‐TAVI CT scan.

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  FIGURE 2. Reconstruction of the aortic valve using pre‐TAVI CT scan to highligth calcifications in the left coronary and non‐coronary cusps. (A) Illustration showing calcifications in the left coronary and non‐coronary cusps. (B) 3D reconstruction of the cusps with calcification score. (C and D) Coronal sections depicting calcifications in the left coronary and non‐coronary cusps.

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  FIGURE 3. 3D reconstruction of vascular axes illustrating femoral artery selection and calcifications of the descending aorta (sagittal cross‐section).

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  FIGURE 4. Fluoroscopic images taken during the unsuccessful positioning of the delivery system. (A) Blue arrow indicating calcification in the non‐coronary cusp. (B) Failure of the Edwards THV device to cross the native aortic stenosis location.

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  FIGURE 5. Fluoroscopic images captured during the setup of the Snare Catheter. (A) Insertion of the Snare Catheter (SC) via the left femoral artery into the left ventricle. (B) Withdrawal of the SC to the tip of the delivery system. (C) Advancement of the Safari 2 guide through the loop of the SC, enablng further advancement of the SC to the level of the delivery system.

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  FIGURE 6. Fluoroscopic images showcasing the positioning of the delivery system and the removal of the Snare Catheter. (A) SC progresses to the THV delivery device. (B) Application of SC traction to achieve the correct angulation for valve crossing. (C) SC is pushed to the bottom of the left ventricle. (D) Removal of the Safari 2 guidewire, facilitating the release and extraction of the SC.

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  FIGURE 7. Fluoroscopic images demonstrating successful delivery of the device through the aortic valve without (A) and with (B) the use of a contrast agent (B).