Hirose Suguru, Enta Yusuke, Ishii Kazunori, Inoue Arata, Nakashima Masaki, Nomura Takehiro, Saigan Makoto, Tada Norio
Department of Cardiology, Sendai Kousei Hospital, 4-15 Hirosemachi Aoba Sendai, Miyagi 980-0873, Japan.
Department of Cardiovascular Medicine, School of Medicine, Dokkyo Medical University, Tochigi, Japan.
Eur Heart J Case Rep. 2022 Feb 7;6(2):ytac059. doi: 10.1093/ehjcr/ytac059. eCollection 2022 Feb.
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.
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.
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.
经导管主动脉瓣植入术（TAVI）后，由于主动脉几何形状的改变，冠状动脉通路的建立具有挑战性。经导管心脏瓣膜（THV）的垂直（长轴）视图通常用作主要的透视角度。然而，它并不总是能提供关于选择性冠状动脉开口定位所需旋转轴的足够信息。从右前斜头侧深部位置获得的正面（短轴）视图为我们提供了有关THV与冠状动脉开口三维空间关系的额外信息。
我们展示了3例TAVI术后冠状动脉通路建立的病例。在这些病例中，我们成功地将“正面”视图与垂直视图结合使用。
正面视图的使用补充了垂直长轴视图，因为它有助于在透视过程中理解THV与冠状动脉开口的三维空间关系，并在两个方向上控制导管操作（垂直方向为上下，正面视图为顺时针/逆时针）。我们认为，正面视图有助于提高TAVI术后冠状动脉通路建立的技术成功率。
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