Dargan James, Hampal Rumneek, Khan Faisal, Brecker Stephen
Cardiovascular Clinical Academic Group, St George's University of London and St George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK.
St George's University Hospitals NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, UK.
Eur Heart J Case Rep. 2022 Sep 28;6(10):ytac398. doi: 10.1093/ehjcr/ytac398. eCollection 2022 Oct.
Transcatheter aortic valve replacement (TAVR) is becoming increasingly prevalent worldwide and is now more common than surgical aortic valve replacement. It is expanding into all patient subsets including younger and lower risk patients. Bicuspid aortic valve (BAV) accounts for a significant proportion of TAVR, but due to heterogenous anatomy, it is of increased complexity. One of the greatest challenges in BAV is the selection of the correct TAVR size. Transcatheter aortic valve replacement sizing is based upon computed tomography-derived annular measurements. There are a number of sizing algorithms for BAV based upon anatomical characteristics, often yielding different results. This is noted especially when a patient falls near the borderline between two valve sizes, an anatomical grey zone. Complementary to the algorithm approach is the use of pre-procedural patient-specific computer simulation using finite-element modelling.
An 86-year-old female was treated for heart failure secondary to severe and calcific BAV aortic stenosis with TAVR. Due to anatomical difficulty and grey-zone valve sizing, we demonstrate the use of pre-procedural patient-specific computer simulation with the novel Medtronic Evolut PRO+ platform to achieve a good result.
Using patient-specific computer simulation, we were able to safely select the valve and the deployment height and then accurately predict the result in a difficult, severely calcified BAV. In addition to improving outcome, this allows for patient-specific, tailored discussion to occur at heart team meetings.
经导管主动脉瓣置换术（TAVR）在全球范围内越来越普遍，现在比外科主动脉瓣置换术更为常见。它正在扩展到所有患者亚组，包括年轻和低风险患者。二叶式主动脉瓣（BAV）在TAVR中占相当大的比例，但由于解剖结构的异质性，其复杂性增加。BAV最大的挑战之一是选择正确的TAVR尺寸。经导管主动脉瓣置换术的尺寸确定基于计算机断层扫描得出的瓣环测量值。有许多基于解剖特征的BAV尺寸算法，常常产生不同的结果。特别是当患者处于两个瓣膜尺寸的边界附近，即解剖学灰色区域时，这种情况更为明显。与算法方法相辅相成的是使用术前基于有限元建模的患者特异性计算机模拟。
一名86岁女性因严重钙化性BAV主动脉瓣狭窄继发心力衰竭接受TAVR治疗。由于解剖学困难和瓣膜尺寸处于灰色区域，我们展示了使用新型美敦力Evolut PRO+平台进行术前患者特异性计算机模拟，以取得良好效果。
通过患者特异性计算机模拟，我们能够安全地选择瓣膜和部署高度，然后在困难的、严重钙化的BAV病例中准确预测结果。除了改善治疗效果外，这还使得在心脏团队会议上能够进行针对患者的、量身定制的讨论。
