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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 :;:;=;