Novel Techniques to Crossing a Severely Stenotic Aortic Valve

Figures

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  Figure 1. Pre-Procedural MSCT and Angiographic Views of Crossing the Aortic Valve With the Balloon Cushion Technique in Case 1 (A) Heavily calcified trileaflet aortic valve. (B) Mean annular measurement (25 mm). (C) The sinus of Valsalva measurements (biplane 33× 32.8 mm). (D) Failure to cross the aortic valve despite considerable push and manipulation. (E) Inflation of 1 to 2 cm3 of the distal part of the balloon (blue arrow highlighting the outline of contrast). (F) Successful crossing of the aortic valve following the balloon cushion technique. L = left; MSCT = multislice computed tomography; N = node; R = right.

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  Figure 2. Pre-Procedural MSCT in Case 2 (A) Heavily calcified trileaflet aortic valve. (B) Average annular measurements 24.8 mm. (C) Sinus of Valsalva measurements (biplane 32 × 33.2 mm). (D) Nearly horizontal aorta with an annuloaortic angle of 56°. Avg = average; other abbreviations as in Figure 1.

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  Figure 3. Angiographic Views Demonstrating Difficulty in Crossing the Aortic Valve and Rescue Maneuvers With the Buddy Balloon Technique (A) Sapien Ultra valve (Edwards Lifesciences) and delivery system were unable to cross the aortic valve. (B) Sapien Ultra valve on the outer curve bias despite delivery system and wire coaxial maneuvers. (C) Failure to cross despite use of a Cristal balloon (Balt extrusion; 20- × 45-mm) for valvuloplasty. (D) Deflating and withdrawing the buddy balloon across the aortic valve (blue arrow) while advancing the Sapien Ultra valve (red arrow) to facilitate successful crossing. (E) Successful crossing and implantation of the Sapien Ultra valve.

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  Figure 4. Important Differences Between the Edwards Sapien 3 (Commander) and the Edwards Sapien Ultra Delivery System