CASE:
A 92-year-old petite woman with a BSA of 1.20m2 presenting with very severe AS with a mean aortic gradient of 70mmHg.
FINDINGS:
Preoperative cardiac CT images showed a very small aortic annulus at 18.6 mm diameter (perimeter 58.4 mm) (Figure 1); Sinus of Valsalva diameter (NCC) was 25.2 mm (Figure 2); and sinus of Valsalva height (NCC) was 11.5mm (Figure 3).
TECHNIQUE:
Since the patient has a narrow valve annulus, TAVI was performed via TF approach using a 23mm Evolut PRO+. A SoftNAV pigtail catheter was inserted through the femoral artery. Despite the small aortic root, positioning the SoftNAV pigtail catheter into the non-coronary (NC) sinus was smooth and the pigtail remained stable and did not move from the NC sinus during Evolut valve deployment (Figure 4-6).
CONCLUSION:
Many Japanese AS patients have a small aortic root, similar to the case presented, and there have been many times where a standard 13 mm pigtail loop could not be placed smoothly in the sinus of Valsalva. Since August 2016, our hospital has been using Technowood's SoftNAV catheter pigtail during TAVI imaging especially for difficult aortic root placement cases. In addition, since the catheter shaft has good stiffness and is coated with a hydrophilic coating, the pigtail catheter has excellent trackability and can be easily positioned even in tortuous vessels.
The SoftNAV pigtail catheter was stable during deployment of the 23mm Evolut PRO+
No perivalvular regurgitation after implantation. Mean pressure gradient showed up to 6mmHg improvement.
8mm LOOP:
Tipped with a micro loop designed to easily pass through the aortic valve.
17 SIDE HOLES:
17 non-linear, non-spiral sideholes are positioned on the distal 3cm of the catheter to maximize contrast distribution while reducing catheter whipping movement.
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