Sinus Sequestration After TAV-in-SAV

Figures

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  Figure 1. Neoskirt Plane After Transcatheter Aortic Valve–in–Surgical Aortic Valve and Computed Tomography Planning (A) The pinned open leaflets (neoskirt, tube graft) after transcatheter aortic valve–in–surgical aortic valve (SAV) and (B) assessment of the anatomical relationship using maximum intensity projection images. The view for maximum intensity projection was created by multiplanar images aligning the top of the surgical aortic valve stent frame, with a slice thickness of 0.75 mm, a slab thickness of 20 mm, and a field of view of 200 mm. (C) When the neoskirt plane is above the sinotubular junction (STJ), there is a risk of sinus sequestration, and assessment of valve-to–sinotubular junction (VTSTJ) distances is crucial. (D) Measurements should be performed on the basis of the planned procedure. Avg. = average; LCA = left coronary artery; RCA = right coronary artery; TAV = transcatheter aortic valve; VTAoS = valve-to–aortic sinus; VTC = valve-to-coronary. A, Reproduced from the ViV Aortic App with permission from Dr Vinayak N. Bapat.

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  Figure 2. Optimized Transcatheter Aortic Valve–in–Surgical Aortic Valve Procedure (A) An Evolut FX 23-mm valve (Medtronic) was deployed without pre-dilatation, followed by (B) post-dilatation (optimization) using a 20-mm balloon. (C) Angiogram after post-dilatation confirmed preserved blood flow in the Valsalva sinuses and the coronary arteries.

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  Figure 3. Post-Transcatheter Aortic Valve–in–Surgical Aortic Valve Computed Tomography and Predicted vs Observed VTSTJ Distances (A) Maximum intensity projection images confirming the relationship between the stent frames, coronary ostia, and sinotubular junction. The view for maximum intensity projection was created by multiplanar images aligning the top portions of the surgical aortic valve stent frame, with a slice thickness of 0.75 mm, a slab thickness of 20 mm, and a field of view of 200 mm. (B) The angle between the commissure of the transcatheter aortic valve and the surgical aortic valve was 27.3°, indicating only mild misalignment. (C) The Evolut FX valve (Medtronic) was expanded appropriately without significant deformation, and (C and D) observed valve-to–sinotubular junction (VTSTJ) distances were equivalent to predicted values using the virtual circle. Abbreviations as in Figure 1.