Transcatheter aortic valve replacement planning with cardiac computed tomography in quadricuspid aortic valve stenosis: a case series

Figures

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  Figure 1. Quadricuspid aortic valve, with an accessory cusp between the right and left coronary sinuses, type 1 of the Nakamura classification. 3D reconstruction, with the simulation of the three sinuses.

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  Figure 2. Planning tomographic: (A) Measurement of the depth of the non-coronary sinus (yellow point). (B) Depth of the right coronary sinus (green point). (C) Depth of the left coronary sinus (red point). (D) Measurement of the annulus ring based on the deepest sinus (right coronary sinus, green dot). (E and F) Simulation of the three sinuses in QAV and exclusion of the accessory coronary sinus. (G and H) Cusp overlap and working position.

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  Figure 3. Measurement of virtual landing zone on computed tomography: Descending from the aortic root (purple line), sinutubular junction (orange line), and cusps (green and yellow lines) to the left ventricular outflow track (line blue), the hinge point of each individual aortic valve cusp is identified to establish the plane of the annulus (red line). Virtual ring of aortic annulus was selected at the plane of the circumferential ring at the basal attachment points of the aortic cusps (red line).

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  Figure 4. (A) Pigtail placement in the right coronary sinus, centralization of the same sinus was performed, with the purpose of locating the non-coronary sinus on the left of the image and the left coronary sinus on the right side during the injection of the contrast medium. (B) Pre-dilatation with #18 balloon. (C) Position of the valve at the depth level of the right coronary sinus. (D) Valve deployment without complications.