En face view of the transcatheter heart valve from deep right-anterior-oblique cranial position for coronary access after transcatheter aortic valve implantation: a case series

Abstract

Background Coronary access after transcatheter aortic valve implantation (TAVI) is challenging due to the changes in aortic geometry. The perpendicular (long-axis) view of the transcatheter heart valve (THV) is usually used as the primary fluoroscopic angle. However, it does not always provide sufficient information on the rotational axis needed for selective coronary ostia engagement. The en face (short-axis) view from the deep right-anterior-oblique cranial position gives us additional information about three-dimensional spatial relationship of the THV and coronary ostia. Case summary We present three cases of coronary access after TAVI. We were successful in the use of the “en face” view along with the perpendicular view in these cases. Discussion The use of the en face view complements that of the perpendicular long-axis view since it allows the understanding of the three-dimensional spatial relationship of the THV and the coronary ostia during fluoroscopy and control of catheter manipulation in two directions (up/down for perpendicular and clockwise/counterclockwise for en face view). We believe that the en face view helps improve the technical success of coronary access after TAVI.

Novel percutaneous intervention technique for obstructed coronary artery after valve‐in‐valve transcatheter aortic valve replacement

“…1) The wire crosses the coronary artery easily using JR with reference to en-face and perpendicular views. 3 (Figure 2A,B)…”

“…The current case demonstrated a new PCI technique for coronary artery obstruction after valve‐in‐valve TAVR. Specifically, the PCI technique consists of five steps: The wire crosses the coronary artery easily using JR with reference to en‐face and perpendicular views 3 . (Figure 2A,B) JR imitates a backup catheter using a combination of the JR and guide‐extension catheter, forcing JR to contact the contralateral ascending aorta (a good backup position) (Figure 2C).…”

Commissural alignment in the Evolut TAVR procedure: conventional versus hat marker-guided shaft rotation methods

“…Coronary access after THV implantation is a major concern after TAVR and has been the subject of many studies 10,[13][14][15][16][17] . Aligning the THV neo-commissure with the native commissure can greatly facilitate coronary access after TAVR 18 .…”

Intraprocedural assessment of commissural alignment of the Navitor system using the en-face view

“…The en-face view is useful for comprehending the short-axis orientation in fluoroscopy [ 2 ]. Navitor THV (Abbott, CA, USA) has commissure attachment features (CAFs), which provide a marker for the location of each commissure under fluoroscopy.…”