Transcatheter Aortic Valve Implantation for Native Aortic Regurgitation After Healed Infective Endocarditis

Figures

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  Visual Summary. Controlled Deflection and Repositioning During TAVI Helped Avoid Locator Misengagement Caused by Cusp Perforation in Severe Aortic Regurgitation From Healed Endocarditis AR = aortic regurgitation; TAVI = transcatheter aortic valve implantation.

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  Figure 1. Preprocedural Computed Tomography Assessment of the Aortic Root Anatomy (A) Annular size view. (B) LVOT view showing absence of LVOT calcification. (C and D) Supra-annular/sinus of Valsalva view showing leaflet/root morphology and absence of supra-annular calcification. (E and F) Three-dimensional/MPR view for the aortic valve showing absence of calcification. LVOT = left ventricular outflow tract; MPR = multiplanar reconstruction.

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  Figure 2. Fluoroscopy During Transcatheter Heart Valve Positioning Initial positioning demonstrated 1 locator protruding through the perforated left coronary cusp (asterisk).

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  Figure 3. Use of the Deflector Knob (1) to Adjust the Delivery System, Allowing the Catheter to Move Away From the Aortic Wall and Achieve Improved Coaxial Alignment Within the Aortic Root

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  Figure 4. After Controlled Deflection and Rotational Adjustment, Repeated Fluoroscopic Angiography Showing Coaxial Alignment Above Native Cusp All locators (arrows) are appropriately aligned above the native cusps, avoiding engagement through the perforated cusp. LCC = left coronary cusp; NCC = noncoronary cusp; RCC = right coronary cusp.