Invasive hemodynamic evaluation in patients with mechanical aortic valves

Abstract

Invasive hemodynamic evaluation in the patient with a mechanical aortic valve has in the past required transseptal or apical left ventricular puncture in order to obtain left ventricular pressure measurements. Over the last few years, several case reports have described the feasibility of using a coronary pressure-sensing guidewire to cross mechanical prosthetic aortic valves. In the current manuscript, we report four cases in which the use of a pressure-sensing guidewire was utilized for invasive hemodynamic diagnostic evaluation in patients with mechanical aortic valves. Furthermore, we present a detailed description of the technical approach to this technique and the limitations of this approach.

Invasive hemodynamic evaluation in patients with mechanical aortic valves. Catheterization and cardiovascular interventions: Official journal of the society for cardiac angiography & interventions 2013

“…Since the acceptance for publication of our manuscript [1] (currently published online), a technical development has enhanced the approach of using the coronary pressure wire to quantitate pressure gradients across mechanical prosthetic valves.…”

“…By cineradiography the valve leaflet motion was uniform and normal. Using the coronary pressure wire technique with the SmartMap adapter and retrograde crossing of the prosthetic valve with the 0.014 00 pressure guidewire using the published technique [1], we measured a mean prosthetic aortic valve gradient of 20.7 mm Hg; calculated aortic valve area of 1.96 cm 2 [see Fig. 1 (attached hemodynamic figure)].…”

“…We reported recording and estimating the peak-topeak pressure difference was all that was possible from the Volcano hemodynamic display; software designed to measure mean pressure differences in the coronary vascular bed [1]. Now, an adapter device, the SmartMap Pressure Guide Wire System (Volcano Corporation, San Diego, CA), is available for clinical use [2].…”

Percutaneous interventricular septal access in a patient with aortic and mitral mechanical valves: A novel technique for catheter ablation of ventricular tachycardia

“…1, 2, 10, 11 Coronary pressure sensing wires have been used for invasive hemodynamic evaluation and measurement of bileaflet mechanical valve gradients. 12 However, these techniques are not suitable when larger catheters are needed to be introduced into the LV. Therefore, a percutaneous trans-apical approach has been undertaken for electrophysiology and interventional procedures in the LV.…”