Transcatheter Self-Expanding Valve with a Dual Purpose—Exclusion of a Pseudoaneurysm of the Mitral-Aortic Intervalvular Fibrosa and Treatment of Aortic Stenosis

Figures

• 

  Figure 1. Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (asterisks) Transesophageal echocardiography images (A) with and (B) without Doppler flow filling; (C) angiographic imaging; (I) multiplanar and (E) 3D computed tomography scan. (D) Computed tomography measures of the pseudoaneurysm neck. Transcatheter aortic valve replacement-Navigator multiplanar computed tomography scan pre-procedural planning of the (F) virtual basal ring and (G) of the planned landing plane in which the pseudoaneurysm of the mitral-aortic intervalvular fibrosa is separated from the left ventricular outflow tract by a membrane (white arrowhead). (H) Transcatheter aortic valve replacement-Navigator virtual planning of self-expanding valve implantation.

• 

  Figure 2. (A, arrow) Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF; asterisks) exclusion with balloon aortic predilatation during transesophageal echocardiography imaging and anterior mitral valve leaflet bulged by the balloon’s shoulder; (B, C) SEV underexpansion with severe aortic regurgitation and (C) P-MAIVF indirect filling before postdilatation. (C) P-MAIVF transesophageal echocardiography Doppler filling before postdilatation and (F) absence of P-MAIVF Doppler filling in the same projections after postdilatation with 2 paravalvular leaks. (E) Absence of P-MAIVF indirect angiographic filling and SEV implantation depth more than 6 mm: almost all the height of the first SEV lozange-cell below the annular plane (black line). (G, H) P-MAIVF exclusion in transthoracic echocardiography postprocedural images with the SEV overlaying and overcoming the P-MAIVF’s neck. (G) Mitral valve normal function shown with transthoracic echocardiography.