Underfilled Balloon-Expandable Transcatheter Aortic Valve Implantation With Ad Hoc Post-Dilationã- Pulsatile Flow Simulation Using a Patient-Specific Three-Dimensional Printing Model.
Circ J
; 83(2): 461-470, 2019 01 25.
Article
em En
| MEDLINE
| ID: mdl-30587701
BACKGROUND: Underfilled transcatheter aortic-valve implantation with ad hoc post-dilation is a therapeutic option for patients with borderline annuli to avoid acute complication. The effects of this technique on valve leaflet behavior, hydrodynamic performances, and paravalvular leakage (PVL) using patient-specific three-dimensional (3D) aortic-valve models were investigated. MethodsâandâResults: A female octogenarian patient was treated with this technique by using a 23-mm Sapien-XT. Patient-specific models were constructed from pre-procedure computed tomography (CT) data. Change in aortic annulus areas during systolic/diastolic phases and post-procedure stent areas were adjusted to those of the patient. The following was performed: (1) -3 cc initial and -2 cc underfilled post-dilation to the scale-down model by adjusting percent oversizing; and (2) -1 cc initial underfilling, nominal volume, and repeat nominal volume post-dilation using the patient-specific model. Underfilling was associated with higher %PVL. Observation using a high-speed camera revealed distorted leaflets after underfilled implantation, with a longer valve-closing time and smaller effective orifice areas, especially in the -3 cc underfilled implantation. Micro-CT analysis revealed that the transcatheter valves shifted to the opposite side of the large annulus calcification after post-dilation and reduced the malapposition there. CONCLUSIONS: Excessive underfilled implantation showed unacceptable acute hemodynamics. Abnormal leaflet motions after underfilled implantation raised concerns about durability. Flow simulations using patient-oriented 3D models could help to investigate hemodynamics, leaflet motions, and the PVL mechanism.
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Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Fluxo Pulsátil
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Medicina de Precisão
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Substituição da Valva Aórtica Transcateter
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Impressão Tridimensional
Tipo de estudo:
Evaluation_studies
/
Prognostic_studies
Limite:
Aged80
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Female
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Humans
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article