Left Ventricular Outflow Obstruction After Transcatheter Heart Valve Migration and Stent Infolding

Figures

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  Figure 1. Continuous Doppler on Native Aortic Valve Continuous Doppler shows an aortic valve max of 5.44 m/s.

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  Figure 2. Multidetector Computed Tomography Images of the Native Aortic Valve (A) Measurement of aortic annulus for cross-sectional area and perimeter in end systole. (B) Three-cusp coplanar view. (C) Stretched vessel image, infra-annular membranous septum length 3.6 mm. (D) 3-dimensional reconstructions of valve.

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  Figure 3. Aortograms of THV 1 Deployment (A) ACURATE neo2 large transcatheter heart valve (THV 1) valve shown not deployed. (B) Complete deployment of valve. (C and D) Deformed valve on retraction of delivery system.

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  Figure 4. Aortogram of Wire Crossing and Re-expansion (Left) Wire crossing the deformed valve and (right) re-expansion of valve after balloon dilatation.

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  Figure 5. Aortogram of Deployment and Expansion of THV 2 (Left) The 26-mm SAPIEN 3 Ultra THV (THV 2) not deployed and (right) fully expanded THV 2 in THV 1. Abbreviation as in Figure 3.

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  Figure 6. Cerebral Embolic Protection Cerebral embolic protection shown after procedural removal.

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  Figure 7. Postprocedural TTE Measurements Postprocedural transthoracic echocardiography (TTE) measurements using continuous Doppler on bioprosthetic aortic valve. Continuous Doppler shows an aortic valve max of 2.22 m/s.

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  Figure 8. Multidetector Computed Tomography Images Post TAVR of the Bioprosthetic Valves (1) Stretched left ventricular outflow tract vessel images of (A) THV 1 and (B) THV 2 (2) Distance of THV 1 to left coronary ostia is 4.5 mm. (3) Distance of THV 1 to right coronary ostia is 4.8 mm. TAVR = transcatheter aortic valve replacement; other abbreviations as in Figures 3 and 5.