Transcatheter aortic valve implantation for patient with non-calcified bicuspid aortic valve: a case report

Figures

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  Figure 1. Pre-procedural echocardiography. (A) Pre-procedural transthoracic echocardiography measurements demonstrating severe aortic stenosis (peak velocity 4.9 m/s and valve area 0.66 cm2). (B) Short axis view of the pre-procedural transesophageal echocardiography showing thickened leaflets without calcification. The white arrows show a narrowing of the aortic valve opening. LA, left atrium; RA, right atrium.

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  Figure 2. Pre-procedural computed tomography. (A, B) Pre-procedural computed tomography images showing a non-calcified bicuspid aortic valve. (C) Computed tomography analysis showing a tubular configuration (ICD, 19.4 mm; mean annulus distance, 19.5 mm). CT, computed tomography; ICD, intercommissural distance.

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  Figure 3. Intraoperative fluoroscopy. (A) Fluoroscopy showing the 23 mm Evolut PRO+ valve deployment. The 23 mm prosthesis did not anchor firmly at the appropriate position and migrated easily. (B) Fluoroscopy also revealed the 23 mm prosthesis being pushed up. The 23 mm prosthesis was recaptured. (C, D) The 26 mm Evolut PRO+ valve was deployed under fluoroscopic guidance. The 26 mm prosthesis was deployed at the appropriate position with stable anchoring. SEV, self-expandable valve.

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  Figure 4. Post-procedural echocardiography. (A) The 3-month postoperative transthoracic echocardiography showed a well-functioning valve (peak velocity 1.97 m/s and valve area 1.28 cm2). (B) The short axis view on transthoracic echocardiography showing the implanted device without migration and paravalvular leak . LA, left atrium; RA, right atrium; RV, right ventricular.