PR: Aortenklappen-Implantation (syngo DynaCT Cardiac, Kasuistik)

Patient history:
81-year-old female patient with high grade aortic stenosis and increased operative risk.
 
Diagnosis:
The patient suffers from aortic valve stenosis, pulmonary hypertension and respiratory dysfunction. In addition she had arterial hypertension, chronic atrial fibrillation and diabetes mellitus.
 
Treatment:
Under general anesthesia, a right femoral arterial sheath and a right femoral venous guidewire were inserted. A pigtail catheter was then advanced through the femoral sheath to the aortic root. Left anterolateral mimi-thoracotomy was performed opening the pericardium at the apex of the left ventricle. An epicardial pacemaker lead was then introduced, secured by apical purse-string sutures. syngo DynaCT Cardiac images were acquired under rapid biventricular pacing; 3:1 contrast dilution was injected into the aortic root. Guided by the calculations of the 3D volume, the C-arm was placed in an orthogonal position and the segmented image was overlain onto the fluoroscopic image. An antegrade approach was used to negotiate a soft guidewire across the stenotic aortic valve. A 14 F sheath was then advanced into the ascending aorta. A super-stiff guidewire was also advanced into the descending aorta. During a brief episode of rapid ventricular pacing, a 20 mm balloon was inflated to dilate the high grade aortic stenosis. The balloon catheter was exchanged for a 26 mm sheath, which was advanced to position the aortic valve bioprothesis. Positioning was confirmed by angiography and syngo DynaCT Cardiac. An Edwards SAPIEN aortic valve bioprothesis was successfully deployed during a second episode of rapid pacing. Intraoperative transesophageal echocardiography and angiography revealed no relevant aortic insufficiency. The successful transcatheter valve replacement procedure was performed without open-heart surgery.
 
Author:
Thomas Walther, M.D., Ph.D (Department of Heart Surgery, University Leipzig, Heart Center, Leipzig, Germany)
AXIOM Innovations (November 2009, www.siemens.com/healthcare-magazine)

 

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