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Updated: Jul 8, 2026
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Commissural Alignment During TAVR With a New-Generation Self-Expandable Valve in a Single Coronary Artery
Tomoki Fukui1, Shohei Yamamoto1, Masami Nakagawa1
1Department of Cardiology, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan.
Background:
Transcatheter aortic valve replacement (TAVR) in patients with a single coronary artery (SCA) is challenging because loss of coronary access may have catastrophic consequences.
Case Summary:
A 92-year-old woman with severe aortic stenosis underwent transfemoral TAVR. Preprocedural computed tomography revealed an SCA arising from the left coronary cusp with a small annulus. TAVR was performed using an Evolut FX+ valve with intentional commissural alignment guided by cusp-overlap and en face fluoroscopic views. Postprocedural imaging demonstrated preserved coronary access and flow, with a large stent-frame cell facing the coronary ostium. The patient recovered uneventfully.
Discussion:
Intentional commissural alignment with imaging-guided deployment may preserve coronary access without coronary protection in patients with complex coronary anatomy.
Take-Home Message:
Intentional commissural alignment may facilitate safe TAVR while preserving coronary access in patients with SCA.
