Balloon Sizing-Guided Valve Selection for Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve

Valve size selection for transcatheter aortic valve replacement using a balloon-expandable valve in a bicuspid aortic valve (BAV) involves a trade-off among the risks of aortic rupture, residual paravalvular leak, and inadequate valve expansion. We report 2 cases of type 1 BAVs with a tapered configuration that created challenges regarding valve size selection. Two consecutive valve sizes were considered based on multidetector computed tomography measurements. Therefore, predilatation with contrast injection was performed using a balloon that was slightly smaller than the smaller of the 2 valve sizes. These cases suggest that a smaller valve should be selected when balloon indentation is observed without contrast backflow into the left ventricle because selecting the larger valve may result in insufficient expansion. Balloon predilatation with contrast injection may be a useful strategy for determining the appropriate valve size for transcatheter aortic valve replacement using a balloon-expandable valve in type 1 BAVs with a tapered configuration.