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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
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Direct aortic transcatheter aortic valve implantation
Emir Karaçağlar1, Arzu Neslihan Akgün1, Alp Aydınalp1
1Department of Cardiology, Başkent University School of Medicine, Ankara, Turkey.
Summary
Direct aortic transcatheter aortic valve implantation (TAVI) offers a safe alternative for patients with severe peripheral vascular disease unsuitable for transfemoral access. This case highlights successful DAo TAVI in an 88-year-old with complex anatomy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis.
- Transfemoral (TF) access is the preferred route, but contraindications exist.
- Severe peripheral vascular disease (PVD) can preclude TF access.
Observation:
- An 88-year-old patient presented with cardiogenic shock due to severe aortic stenosis.
- Multislice computed tomography (MSCT) revealed severe PVD and abdominal aorta calcification.
- The patient's anatomy was unsuitable for standard TF TAVI.
Findings:
- Direct aortic (DAo) TAVI was successfully performed using a 26-mm Medtronic CoreValve Evolut R.
- The procedure involved predilatation and implantation via median sternotomy.
- The patient was discharged within 96 hours post-procedure.
Implications:
- DAo TAVI is a viable alternative for select patients with contraindications to TF access.
- Thorough preprocedural MSCT evaluation is crucial for successful DAo TAVI planning.
- MSCT aids in identifying optimal cannulation zones for DAo TAVI procedures.
