case_images: PMC11779679_01
case_images: Pre-procedural echocardiographic pressure gradients over surgical aortic bioprostheses.
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case_images: F1
case_images: Trivial transvalvular aortic regurgitation was noted, and left ventricular ejection fraction (LVEF) was preserved at 55% (Fig. 1).
case_images: Diameters of the aortic annulus, SOV, LVOT, STJ, and ascending aorta were measured on CT. The last image shows a heavily calcified aortic annulus. CT: computed tomography; LVOT: left ventricular outflow tract; SOV: sinus of Valsalva; STJ: sinotubular junction.
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case_images: F2
case_images: The perimeter derived of the annulus, as determined by CT, was 20.8 mm (Fig. 2).
case_images: Sinus of Valsalva heights measured on CT (LCC, RCC, and NCC, respectively). CT: computed tomography; LCC: left coronary cusp; NCC: non-coronary cusp; RCC: right coronary cusp.
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case_images: F3
case_images: Additionally, optimal heights of the sinuses of Valsalva were observed (left coronary cusp ((LCC) 22 mm, right coronary cusp (RCC) 26 mm, non-coronary cusp (NCC) 24.5 mm)) (Fig. 3).
case_images: Aortic arch and aortic root angulation. Separate origins of brachiocephalic trunk, left carotid artery, and left subclavian artery were seen.
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case_images: F4
case_images: The aortic root angulation was measured at 30 , and the CT revealed separate origins of the brachiocephalic trunk, left carotid artery, and left subclavian artery suitable for cerebral protection device (Fig. 4).
case_images: The right femoral artery was chosen for the main access site, without significant tortuosity or notable calcification seen on CT. CT: computed tomography.
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case_images: F5
case_images: No significant tortuosity was seen in the left and right iliac arteries, and the CT scan revealed no notable calcification (Fig. 5).
case_images: Valve-in-valve TAVR - implantation of ballon-expandable Myval Octacor valve into previously implanted bioprothesis. TAVR: transcatheter aortic valve replacement.
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case_images: F6
case_images: Post-dilation with the +1 cc balloon was conducted due to residual pressure gradient over the valve (Fig. 6).
case_images: Post-procedural pressure gradients over aortic valve.
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case_images: F7
case_images: A mean gradient of 15.37 mm Hg and a maximal gradient of 30.83 mm Hg were measured, with trivial aortic regurgitation (Fig. 7).