Page 29 - Journal of Structural Heart Disease - Volume 1 Issue 1

23
Original Research Article
Figure 3.
Figure 3 Video.
completely non-standardized. A caveat is that the tip of the pigtail used for injection may be trapped between the balloon and the aortic wall, especially if the sinotubular junction is small in diameter, and a power injection may result in a dissection of the aortic root. During contrast injections it is often difficult to assess whether there is significant contrast regurgitation around the balloon. Generally little or no contrast regurgitation into the left ventricle especially when associated with a balloon that locks into the native aortic anulus during inflation suggests that a valve prosthesis frame of about that diameter will be successful.
BAV Techniques
Retrograde BAV
The technique retrograde BAV was described initially for pediatric patients in 1985 and first reported in adult patients with degenerative calcific aortic stenosis in 1986. The technique was largely unchanged for two decades. More recently, several advances have contributed to the predictability of the procedure and its practically [10]. Balloons for BAV
After arterial access is obtained, the valve is crossed us- ing an AL1 diagnostic catheter and a straight tipped guide wire.
ambiguity when TAVR device sizing is problematic is to inject contrast in the aortic root during the BAV for TAVR predilatation. A balloon size is typically select- ed to approximate the short axis CT diameter of the valve. The short axis dimension of the annulus can also be ascertained from the typical transthoracic or transesophageal log axis echo.
The balloon is inflated and contrast is injected into the aortic root at the peak of balloon inflation (Figure 1). CT measurements prior to planned TAVR were borderline for a 23-mm vs. a 26-mm Edwards S3 implant. Hand injection of contrast during BAV with a 22-mm balloon showed locking of the balloon and no contrast regurgitation around the balloon. A 23-mm valve was implanted with a good result, including minimal paravalvular leak. The use of hand injections or various forms of power injections is
Feldman, T. et al.
Balloon Aortic Valvuloplasty