Acurate Neo2 for valve-in-valve treatment of degenerated 3F Enable sutureless bioprosthetic valve in nonagenarian patient: a case report

Figures

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  Figure 1. Transthoracic echocardiography showing severe intravalvular aortic regurgitation (A) with Doppler aortic pressure half time of 201 ms (B) and holodiastolic reverse flow in descending aorta (C).

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  Figure 2. Multi-detector computed tomography study. (A) Measurements of the annulus of the surgical aortic valve; (B) measurements of sino tubular junction and its relationship with sutureless bioprosthetic valve; (C–H) 3D rendering of sutureless bioprosthetic valve and both coronary arteries with an estimation of coronary height (H) from the annulus level and virtual transcatheter heart valve-to-coronary ostium distance. RCA, right coronary artery; LCA, left coronary artery; H, coronary height; VTC, virtual transcatheter heart valve-to-coronary ostium distance.

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  Figure 3. Valve-in-valve transcatheter aortic valve implantation procedure: (A) crossing of the surgical valve and positioning of the Safari pre-shaped 0.035″ wire in the left ventricle; (B) Acurate Neo2 deployment 3 mm under the lower edge of sutureless bioprosthetic valve hesitating in a slight underexpansion of the transcatheter valve frame; (C) post-dilatation with 24 mm valvuloplasty balloon; and (D) final angiographic result with optimal surgical valve sealing and good expansion of the transcatheter valve frame.

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  Figure 4. (A, B) Post-procedural transthoracic echocardiography with residual gradient of 4 mmHg without significant leak. (C) Transthoracic echocardiography at 6-month follow-up showing no substantial increase in transvalvular gradient (Vmax 1.65 m/s, mean gradient 6 mmHg).