0:01

In this case,

0:02

we're gonna review that same bicuspid valve case that we saw before with two

0:07

separate sinuses. And now look at the post TTR results.

0:10

So this patient got a self-expanding aortic valve and you can see those

0:15

really chunky calcifications that we visualized on the, uh,

0:19

previous exam, the pre TAVR exam.

0:22

And they're pressing up against the edge of this TAVR device.

0:26

And so I just want to show you how that looks on the short axis images.

0:30

So again, we're gonna go for the coronal image,

0:34

drop our cross hairs at the level of the valve rotate,

0:37

so we're parallel more or less to the valve plane.

0:41

And then do the same for the other long axis image.

0:45

And that allows us to get this nice short axis view

0:49

through the aortic root and the annulus region.

0:53

And you can see here's the top of the TAVR device.

0:57

And as I scroll downward first you can see that the coronaries are open

1:02

and they're well perfused. And then as we go down inferiorly,

1:06

let's take these distance measurements away.

1:09

You can see this big hunk of calcification,

1:12

which is displacing the edges of the TAVR device towards the center.

1:17

So this is resulting in incomplete opposition of

1:22

the TAVR struts to the aortic annulus. Um,

1:25

and you can see there's actually a little bit of a gap underneath of this. Now,

1:29

whether or not this causes actually results in paravalvular leak is something

1:34

that we will figure out based on echocardiography that does a really good job of

1:38

seeing whether there's any retrograde flow on their Doppler assessment.

1:44

It does look like this patient would probably be at high risk for some degree of

1:48

paravalvular leak. You know,

1:50

usually you can find little areas like this where there's, um,

1:53

a gap around the device at the level of the anulus that's concerning.

1:58

So in this particular case, you can see that there's this big hunk of calcium.

2:02

There's this gap down here.

2:05

So it depends a little bit on where that covered portion of the device is gonna

2:08

end up. But certainly you would wonder about this patient having, um,

2:12

paravalvular leak.

2:14

So this is one of the reasons why when we look at patients with bicuspid valves,

2:19

we often find that they have a higher risk of getting para regurgitation.