Transcatheter Aortic Valve Replacement in Degenerated Perceval Bioprosthesis: Clinical and Technical Aspects in 32 Cases

Figures

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  Figure 1. Preprocedural planning with ECG gated medium contrast CT scan. (A) Sizing of the landing zone (Perceval inflow ring) diameters, area and perimeter; (B) aortic root dimensions; (C) right coronary artery take off; (D) left coronary artery take off.

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  Figure 2. Crossing degenerated Perceval with AL catheter and straight tip guide wire.

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  Figure 3. Crimped THV proper positioning.

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  Figure 4. Soft predilatation and flossing.

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  Figure 5. Final result.

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  Figure 6. Radiological anatomy of Perceval. The Ni-Ti alloy radiopaque stent is clearly visible. (A) Fluoroscopic view; (B) CT scan long axis view; (C) CT scan short axis view.

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  Figure 7. A case of wrong Perceval crossing outside the outflow ring, laterally and then inside the inflow ring with impossibility to advance and deliver the THV.

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  Figure 8. Preprocedural CT scan shows the inflow ring of a degenerated Perceval; a certain level of eccentricity is clearly visible with a sort of rounded triangular shape. (A) Post VIV-TAVIR CT scan of the same prosthesis, we can appreciate a circumferential expansion with minor diameter passing from about 2.05 cm to about 2.3 cm (B).

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  Figure 9. (A) THV delivery is not correct; going too deep in the ventricle may lead to suboptimal THV hemodynamic and earlier degeneration. (B) Angiography shows the absence of a paravalvular leak despite a deep delivery.

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  Figure 10. Radiological markers in Perceval. (A) Fluoroscopic view; (B) CT scan long axis view; (C) CT scan short axis view.