Continuous Assessment of Left Ventricular Outflow Obstruction in Transcatheter Aortic Valve Implantation

Figures

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  Figure 1. Detecting LVOT Obstruction Using Continuous Pressure Monitoring With the SavvyWire During TAVI (A and B) TTE and CT demonstrating the interventricular septal bulge. (C) All cusps of the aortic valve are severely calcified. (D) TAVI was performed, with the prosthesis delivered using the SavvyWire, while continuously monitoring LV pressure. (E) Before valve implantation, the SavvyWire showed an elevated LV pressure. Aortic pressure exhibited a lower peak compared to LV pressure, confirming the presence of severe aortic stenosis. (F) After valve implantation, a marked drop in aortic pressure was observed, and the SavvyWire revealed a further significant increase in LV pressure and a late systolic peaking of the pressure waveform. These findings indicated acute LVOT obstruction. CT = computed tomography; LV = left ventricle; LVOT = left ventricular outflow tract; TAVI = transcatheter aortic valve implantation; TTE = transthoracic echocardiography.

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  Figure 2. TAVI Workflow Using the SavvyWire (A) First, pressure equalization is performed in the ascending aorta. (B) After the standard TAVI procedure, the SavvyWire is advanced into the LV to allow simultaneous measurement of the aorto-LV pressure gradient. (C) Subsequently, rapid pacing is performed using the SavvyWire during valve deployment. (D) Finally, the aorto-LV pressure gradient is reassessed with the SavvyWire for the final evaluation. In cases where a residual pressure gradient remains, postdilatation is considered. LV = left ventricle; TAVI = transcatheter aortic valve implantation.

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  Visual Summary. Pressure Waveform During TAVI Using the SavvyWire The SavvyWire is a next-generation guidewire that enables both rapid pacing and continuous real-time aorto-LV pressure monitoring. This case report describes a patient who developed dynamic LVOT obstruction immediately after valve implantation, in whom continuous assessment of the aorto-LV pressure gradient facilitated prompt diagnosis and treatment. LV = left ventricular; LVOT = left ventricular outflow tract; TAVI = transcatheter aortic valve implantation.