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Anatomical Requirements

Model Annulus size Ao asc diameter

P3-640 20-23 mm 40 mm

P3 943 24-27 mm 43 mm

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CoreValve prosthesis in position

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Implantation aproaches

Transfemoral 18Fr.

Subclavian 18 Fr.

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Ingredients for Success

Proper Patient Selection Operator Eperience

!ood Per Operati"e #are !ood Post Operati"e #are

Strict Attention-to-$etail

%se t&e 'i(&t Materials

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Patient Selection

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What do we need for good patient selection

#omplete An(io(ram#A!) Aortic root) Aorta) *emoral Access)

Su+cla"ian Access) Measurements

,EE

Measurements) $ierent .ie/s #, scan

2$ 'econstruction o Aortic 'oot) .ascular

Sstem

Patient O"er"ie/

#o-Mor+idities) #linical 1istor

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Angio of RCA

oo or #A$ and i treatment is needed) perorm P# +eore PA.'5

oo to t&e coronar ostium and its position

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Angio of Grafts

Al/as c&ec i all t&e (rats are patent) perorm P# +eore PA.' i

needed5 Also c&ec ori(in o (rat5

graft

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Angio of Aortic Root

An(io o Aortic 'oot /it& use o a (raduated pi(tail cat&eter) measure t&e

distances as s&o/n in t&e picture5

Sinus width

STJ4 cm

Ascending AO

Sinus height

Always use 2 planes

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Angio of Aortic Arch

$etermine i t&ere are an a+normalities t&at could cause a diicult

implantation) Per&aps an an(io o t&e carotid arteries s&ould also +e perormed

Graduated igtail

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Angio of abdominal Aorta

$etermine i t&ere are an a+normalities t&at could cause a diicult implantation

Graduated igtail

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Angio of bifurcation an Iliacs

$etermine i t&ere are an a+normalities t&at could cause a diicult

implantation5Measure t&e diameter o t&e arteries en loo or calciications

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Angio of femoral arteries

$etermine i t&ere are an a+normalities t&at could cause a diicult implantation5

oo at puncture site and determine i access and closure is possi+le

uncture site

Femoral arter!

Femoral "ead

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Invasive easurements

#$%F

Gradients ma& mean

ressures '( #$( #$%)( A( *$(

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Parasternal !ong A"is View

)iastolic arasternal view

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Parasternal !ong A"is View

Annulus + #$OT measurement

annulus

#$OT

height

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Parasternal !ong A"is View

Aorta root measurements

sinus

,unction

4 cm

Ascending ao

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Parasternal Short A"is View

This view shows the tricus-id aortic valve. The short a&is view shows

the three aortic cus-s the right and left coronar! cus- and the non coronar! cus-.

#**

/**

0**

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Apical # chamber View

Transthoracic a-ical 4 chamber view shows all -arts of the heart with normal dimensions.

/ight ventricle and left ventricle above2 with right atrium and left atrium in one -lane.

The mitral and tricus-id valves are at the same level. Some -ulmonar! veins are usuall!

visible from this -osition.

#**

/**

0**

/$OT

AO$

#A

#$

#A

/A

/$

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Parasternal !ong A"is View

Aortic valve insufficienc! during diastole. 0o colourshould be visible in this area( the blue colourconfirms the -resence of Aortic insufficienc!.

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Apical # chamber view$ Severe itral Regurgitation

3/ -roduces a high velocit!( turbulent s!stolic flow disturbance in the left

Atrium. *olor )o--ler is slightl! more sensitive than and * techni5ues

because eccentricall! -ositioned and small ,ets are less li6el! to be missed with

*olor )o--ler.

Grade 79

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Apical # chamber view

Transthoracic a-ical 4 chamber view shows tracing of the left ventricle during diastole#$%)

0ormal %F 7 :;:;=;