0:00

With this case, we're gonna review how a, um,

0:04

typical piece of TAVR related, um, analysis software works.

0:09

And for this software,

0:10

what it's doing is sort of stepping you through the various measurements that we

0:14

need to make for TAVR analysis. And again,

0:17

this is just one particular type of software, uh, for this purpose. Um,

0:20

different vendors have different approaches,

0:22

but they all have a similar starting point,

0:25

which is to identify the aortic annulus. So for this particular software,

0:30

the way to identify the aortic annulus is that we, um,

0:33

scroll through on these short axis images. After the,

0:36

it's automatically identify the aortic root and we look at the valve cusps.

0:41

So you can see here's the right cusp left and the non coronary cusp.

0:45

And then you place a marker at the bottom most aspect of the right

0:50

coronary cusp and then scroll up and down again.

0:52

And then put a marker at the bottom most aspect of the left coronary cusp.

0:57

And then finally do the same thing for the bottommost aspect of the non coronary

1:01

cusp there. And then you can use these long access views to uh,

1:05

basically confirm that your markers in the correct spot. So for instance,

1:09

I can grab here and I can look at my little yellow dot and I can see

1:14

that, uh, maybe it needs to be just tiny bit lower at the bottom of that cusp.

1:18

Then I can check the red dot and I can see that there's this valve coming across

1:21

here with some calcification. And I'm gonna put it right there.

1:24

That's the most basal point of that cusp. And then finally for the uh,

1:29

green one over here, the right coronary cusp,

1:32

I can check it again on the long axis views and just confirm it's location

1:35

there.

1:37

We want to aim for a spot right below where the valve leaflet

1:42

inserts into the wall of the L V O T and just put your dot right there.

1:47

And then once you do that, you've got your annular plane,

1:51

also known as the basal plane. And so for this particular software,

1:54

I'm gonna hit confirm and tell it that this is my basal plane.

1:59

And then once you do that,

2:00

it opens up several different windows that give you options for things to

2:03

measure within an anular plane.

2:05

And so we're gonna start with measuring the actual aortic annulus itself.

2:09

From here,

2:10

what I'm going to do is I'm gonna measure a perimeter as well

2:15

as an area and maximum and minimum diameters. And for this particular software,

2:20

you can do a measurements of a polygon,

2:25

I believe, if I remember correctly.

2:27

And you click around the edges of the annulus and

2:32

double click at the end.

2:34

And then you get an automatically generated diameters as well as a perimeter.

2:39

And you'll notice that I kind of went right through the calcium there.

2:43

You can kind of adjust it a little bit. My,

2:45

my tendencies that sort of more or less stick with the outer dimensions of the

2:50

actual annulus itself rather than making a say for instance,

2:55

something that looks kind of like this,

2:56

where you're kind of like bumping up around the calcium.

2:59

Um,

2:59

I think that's not a real correct representation of the perimeter that we want

3:03

to use to define the size of the device.

3:06

So usually I tend to sort of cut through the calcium as if it wasn't there more

3:10

or less.

3:11

And match the perimeter of the rest of the annulus is sort of established by

3:15

the, the rest of that oval there. So then these numbers here,

3:20

min max,

3:21

and then the area and perimeter are what we're gonna add to the report that we,

3:25

uh, give to our referring colleagues.