In patients with obstructive sleep apnea (OSA), diminished change in brainstem activity during swallowing and reduced cerebrovascular reactivity may contribute to the etiopathogenesis and adverse cerebrovascular consequences, respectively. We speculate that decreased cerebral auto-regulation may be causative of gray matter loss in OSA.

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Background: We evaluated the utility of the HeartNavigator III software (Philips Healthcare, Netherlands) to create a patient specific three-dimensional model using ECG-gated CT images to plan Transcatheter Aortic Valve Replacement (TAVR) in a patient with previous Starr-Edwards mitral prosthesis. Methods: A patient with a previous Starr-Edwards mitral prosthesis considered too high risk for conventional surgery required TAVR. It was uncertain whether this would be possible whilst avoiding the complication of the aortic prosthesis interacting with the high-profile Starr-Edwards cage and ball valve mechanism. To ensure it would be feasible and aid in the planning of the procedure a patient specific three-dimensional model was created from ECG-gated CT images using HeartNavigator III software (Philips Healthcare, Netherlands). Results: The patient specific model allowed simulated "virtual" TAVR implantations to be performed with different models and sizes of aortic prosthesis. These preimplant simulations allowed a safe and feasible implant strategy to be chosen. The images were also co-registered with fluoroscopy to guide deployment. Conclusion: Using a patient-specific CT simulation technique we performed TAVR with a high level of precision, achieving a clear margin between a Portico (Abbot Vascular, US) TAVR and the Starr-Edwards cage.

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