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Updated: Jul 27, 2026
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Using Ping-pong technique along with rapid inflate-deflate ballooning to solve total left main occlusion during
Arditya Damarkusuma1,2, Sofian Johar1,3, Billal Patel1
1Gleneagles Jerudong Park Medical Centre, Jerudong, Brunei Darussalam.
Insights
Coronary obstruction during transcatheter aortic valve replacement (TAVR) is a serious risk. The novel "Ping-pong" technique and rapid balloon maneuvers offer new solutions for engaging coronary arteries during TAVR.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Coronary obstruction is a significant complication during transcatheter aortic valve replacement (TAVR).
- Engaging the left main coronary artery through TAVR access points can be challenging.
- Effective strategies for preventing and managing coronary obstruction are crucial for patient safety.
Observation:
- A case of coronary artery obstruction following TAVR deployment is presented.
- Difficulty was encountered in engaging the left main coronary artery through the TAVR prosthesis.
- A novel approach, the "Ping-pong" technique, was employed using a second guide catheter.
Findings:
- The "Ping-pong" technique involves inserting a wire into the Valsalva sinus.
- A rapid inflate-deflate balloon maneuver was utilized to facilitate catheter access.
- This maneuver successfully enabled engagement of the left main coronary artery.
Implications:
- The "Ping-pong" technique and rapid balloon maneuvers represent valuable bailout strategies for coronary obstruction during TAVR.
- These innovative interventions can improve catheter engagement in complex TAVR scenarios.
- Successful management of coronary obstruction can enhance patient outcomes and procedural success rates in TAVR.
Abstract:
Coronary obstruction during transcatheter aortic valve replacement (TAVR) poses a significant threat, prompting a closer examination of prevention and bailout strategies. Following TAVR deployment with a coronary artery obstruction complication and recognizing the complexities involved in engaging the left main coronary artery through TAVR cells. This case introduces the "Ping-pong" technique using a second guide catheter. When faced with difficulty in engaging the catheter through TAVR cells, an innovative solution is proposed. Inserting a wire into the valsalva and utilizing a rapid inflate-deflate balloon maneuver successfully facilitates catheter access into the left main, offering a promising intervention for challenging scenarios. In conclusion, this study emphasizes the severe implications of coronary obstruction during TAVR. The innovative "Ping-pong" technique and rapid inflate-deflate balloons emerge as valuable interventions, showcasing their potential in challenging catheter engagement scenarios. These insights offer a promising avenue for enhancing patient outcomes in TAVR procedures.
