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Ex Vivo Intravascular Ultrasound Assessment of Transcatheter Valve Deformation in Bicuspid Anatomy
Karol A Sadowski1, Michał Kania1, Jarosław Kuriata1
1National Institute of Cardiology, Warsaw, Poland.
Background:
Transcatheter heart valve (THV) deployment in severely calcified bicuspid aortic valve (BAV) can result in complex frame deformation. Large field-of-view intravascular ultrasound (IVUS) offers a tomographic real-time assessment of this phenomenon.
Case Summary:
A 53-year-old male underwent surgery for severe calcific BAV stenosis. Ex vivo, a 26-mm Evolut THV was deployed inside the excised BAV specimen without balloon predilatation or postdilatation to preserve native calcified constraints. Automated IVUS pullback with a 10-MHz IVUS (Visions PV .035, Philips) over a 0.035-inch guidewire revealed severe inflow constraint (41.2% expansion) but preserved expansion at the leaflet nadir (107.6%) and coaptation (104.5%) levels.
Discussion:
While recent clinical computed tomography studies report THV frame decoupling, real-time procedural imaging remains limited. This case provides direct mechanistic proof of how a rigid calcified raphe causes this segmental deformation.
Take-Home Messages:
IVUS demonstrated inflow-to-functional-frame decoupling. Severe inflow constraint may coexist with preserved supra-annular leaflet-level expansion.
