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Redo TAVR With Asymmetric Coronary Risk: Interpreting Borderline CT Findings
Connor J McKechnie1, Nicolas J Valle1, Omar A Saleh1
1Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Eastern Virginia Medical School, Norfolk, Virginia, USA.
Image(S):
Computed tomography (CT) and computational modeling (DASI) in redo transcatheter aortic valve replacement (TAVR) planning.
Case Summary:
A 77-year-old woman presented with severe symptomatic aortic stenosis due to degeneration of a prior transcatheter valve. CT demonstrated leaflet calcification with borderline left-sided valve-to-coronary distance (3.27 mm). Geometric assessment suggested low right coronary obstruction risk, but higher left main risk. Computational modeling demonstrated adequate leaflet-coronary clearance (distance from displaced leaflet cusp to coronary ostium normalized to coronary diameter >0.7). Redo TAVR with a 26-mm Evolut FX was performed without leaflet modification and no coronary obstruction.
Take-Home Message:
Borderline CT findings in redo TAVR require coronary-specific interpretation; computational modeling may provide reassurance when avoiding leaflet modification.
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