Percutaneous aortic valve implantation using novel imaging guidance

Thorough imaging of the aortic valve and related structures is highly important before and during percutaneous valve implantation. However, imaging modalities currently used in the catheterization room, namely, conventional aortography and transesophageal echocardiography are limited in guiding the precise valve placement during the implantation procedure. A novel real-time imaging modality capable of three-dimensional reconstruction of the ascending aorta has recently been introduced (CardioOp-THV, C-THV, Paieon Inc., Park Afek, Israel). We applied this system during a complex procedure of percutaneous aortic valve implantation in a patient with severe aortic tortuosity, large aortic-valve angulation, and asymmetric septal hypertrophy. We found the guidance system very helpful not only for accurate positioning of the valve but also for selecting the optimal projection for valve implantation, selecting the prosthetic valve size, and evaluating the results after deployment.