Anatomical Requirements

Model Annulus size Ao asc diameter

P3-640

20-23 mm

40 mm

P3 943

24-27 mm

43 mm

CoreValve prosthesis in position

Implantation aproaches

Transfemoral 18Fr.
Subclavian 18 Fr.

Ingredients for Success

Proper Patient Selection

Operator Experience
Good Per Operative Care
Good Post Operative Care
Strict Attention-to-Detail
Use the Right Materials

Patient Selection

What do we need for good patient selection

Complete Angiogram
CAG, Aortic root, Aorta, Femoral Access,
Subclavian Access, Measurements

TEE
Measurements, Different Views

CT scan
2D Reconstruction of Aortic Root, Vascular
System

Patient Overview
Co-Morbidities, Clinical History

Angio of RCA

Look for CAD and if treatment is needed, perform PCI before PAVR.
Look to the coronary ostium and its position

Angio of Grafts
graft

Always check if all the grafts are patent, perform PCI before PAVR if
needed. Also check origin of graft.

Angio of Aortic Root

Ascending AO

4 cm

STJ
Sinus width

Sinus height

Always use 2 planes

Angio of Aortic Root with use of a graduated pigtail catheter, measure the
distances as shown in the picture.

Angio of Aortic Arch

Graduated Pigtail

Determine if there are any abnormalities that could cause a difficult

implantation, Perhaps an angio of the carotid arteries should also be performed

Angio of abdominal Aorta

Graduated Pigtail

Determine if there are any abnormalities that could cause a difficult implantation

Angio of bifurcation an Iliacs

Determine if there are any abnormalities that could cause a difficult

implantation.Measure the diameter of the arteries en look for calcifications

Angio of femoral arteries

Femoral artery
Puncture site
Femoral Head

Determine if there are any abnormalities that could cause a difficult implantation.
Look at puncture site and determine if access and closure is possible

Invasive Measurements
LVEF
Gradients Pmax Pmean
Pressures BP, LVP, LVEDP, PAP, CVP,

Parasternal Long Axis View

Diastolic Parasternal view

Parasternal Long Axis View

height

LVOT
annulus

Annulus LVOT measurement

Parasternal Long Axis View

4 cm

Ascending ao
junction
sinus

Aorta root measurements

Parasternal Short Axis View

RCC

LCC

NCC

This view shows the tricuspid aortic valve. The short axis view shows
the three aortic cusps: the right and left coronary cusp and the non coronary cusp.

Apical 4 chamber View

RCC
LV
RV
LCC
RVOT
RA
AOV
NCC

LA
LA

Transthoracic apical 4 chamber view shows all parts of the heart with normal dimensions.
Right ventricle and left ventricle (above) with right atrium and left atrium in one plane.
The mitral and tricuspid valves are at the same level. Some pulmonary veins are usually
visible from this position.

Parasternal Long Axis View

Aortic valve insufficiency during diastole. No colour

should be visible in this area, the blue colour
confirms the presence of Aortic insufficiency.

Apical 4 chamber view. Severe Mitral Regurgitation

Grade >II+

MR produces a high velocity, turbulent systolic flow disturbance in the left

Atrium. Color Doppler is slightly more sensitive than PW and CW techniques
because eccentrically positioned and small jets are less likely to be missed with
Color Doppler.

Apical 4 chamber view

RCC
LV
RV

LV
LCC

RA
AOV
NCC

LA
LA

Transthoracic apical 4 chamber view shows tracing of the left ventricle during diastole:LVED

Normal EF > 60%

Mild EF between 50-60%

Moderate EF between 40-50%

Severe EF 30%

Echo Measurements

AVA
LVEF
LVOT
Annulus
Distance to AML
Gradients Pmax Pmean
Velocity
Dimensions of the 4 chambers
LVH and IVS
Regurgitations

CT reconstruction of Aortic root

Ascending AO
4 cm
STJ
Sinus width
Sinus height

ANNULUS

Always use 2 planes

CT reconstruction of Aortic Root. Measure the distances as shown in the
picture. Good view on calcification. Correct reconstruction angle needed

CT reconstruction of Aorta

Calcifications are clearly visible

CT reconstruction of arteries

Several reconstruction can be made to determine; elongation,

calcification and or other abnormalities

Puncture level femoral arteries

RFA

LFA

Normal CT Slice ( one of a large series) to determine diameter and

calcification at any level.

Good Per Operative care

Full Monitoring
Full Anesthesia or Sedation
Cardiac support standby
Echo standby
Surgical backup

Good Post Operative Care

Full Monitoring after procedure

A lot of hemodynamic changes

ECG Monitoring for 2-3 days

Chances of condunction issues

Strict Attention to Detail

Every Step in the Procedure is Important

Full attention is needed until patient
leaves the hospital.

Use the Right Materials

List of standard materials will be supplied

Patient Selection Material

Complete filled in Patient Selection Form

CDs with DICOM-compatible images of all screening exams
Complete filled in Euro Score worksheet
EKG (recent and complete)
All patient information including DICOM disks must be
received 3 weeks before the scheduled procedure date!

Patient Selection Form

Thank You