PressureWire for comprehensive hemodynamic assessment in a patient with mechanical aortic and mitral valves

This is a case of a 65-year-old male with history of double mechanical valve implantation (aortic and mitral) who presented with symptoms of severe volume overload either related to cardiac disease or underlying cirrhosis. The precise etiology could not be determined by clinical examination and noninvasive diagnostic tests. A cardiac catheterization was deemed necessary to better clarify the diagnosis. Because of the presence of double mechanical valves, crossing the valves with a pigtail catheter and the 0.035-inch wire is contraindicated, traditionally necessitating transapical left ventricular puncture. The pressure wire is an intracoronary wire with a transducer affixed to its distal portion which is indicated for fractional flow reserve determination. We decided to use it in our patient as an off-label indication to cross the mechanical aortic valve safely and record all necessary hemodynamic measurements. Figures are shown of the comparisons between different intracardiac chambers in order to arrive at a final diagnosis without transapical puncture.