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With this case,

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we're going to review a self-expanding core valve device and just take a look at

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some of the important features of these devices.

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So this is a axial stack I'm reviewing with my pacs, um,

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which also has an N P R feature which we're gonna use to look at some obliques

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of this device. So first, just starting on the axial stack,

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you see that compared to the balloon expanded device,

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the self-expanding device is a lot taller. Um,

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you can see struts going all the way up to the ascent aortic,

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the level of the right pulmonary artery here.

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And you see that you have nice apposition all the stent struts to the aortic

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wall. And as we head down you can actually see that there's a gap

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between the edge of the struts and the sinuses here.

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And there's the right coronary artery origin and up higher you can see the gap

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between the edge of the struts and the left coronary sinus here at the level of

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the left coronary artery origin. And that's good. That's what you wanna see.

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That means that you've got good blood flow to those vessels.

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And I'll also point out at the bottom of the gap,

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which is the bottom of the sinuses,

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you have these chunks of calcification here and here.

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And those are the basically pieces of calcification that are on

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the displaced valve leaflets that are now sort of stuck in the cusps pushed

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outta the way by the device itself.

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Now I'm gonna transition to some other views with this type of N P R that I have

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on my pacs. Don't worry about this red line that's a little bit distracting.

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It's not really valuable to review. We'll just concentrate on the,

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the white lines for our locations in the three D plane.

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And I'm gonna rotate a little bit First, actually,

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let's start with this coronal, move this outta the way.

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You can see some differences again from between this type of device and the

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balloon expanded device. Again, it's a much taller device and uh,

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it has this sort of narrow neck and then it gets a little bit bigger up top.

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And that's typical of this type of device. And again,

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the blood flow here we make sure that we preserve coronary blood flow by having

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big,

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spacious sinuses that allow blood flow around the device between these struts.

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The covered portion of the device is somewhere in this area here.

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This part's covered by fabric preventing paravalvular leak or retrograde

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flow around the device. The actual valve itself, it's hard to see the leaflets,

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but they're suspended right around in this region.

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So actually slightly higher than the the native valve level. And then again,

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just above that level of the valve,

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you're gonna have the end of the covered part of the device and then open gaps

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between the parts of the stent structure itself that allows flow of blood into

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the coronary arteries. Again, just uh,

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point out this big ker calcium here.

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That was from a very large ker calcium along the, um,

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non coronary cusp that was displaced by a placement of this device. And,

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and similarly in a big hunger calcium here,

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probably a combination of displaced calcium as well as calcium and the animus on

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this particular device. One last thing,

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I just wanna show you the short axis view.

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In this particular case, you can see the coronaries and their origins here,

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which look great. Also, notice that the device itself is not circular,

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although they come out, you know, from the manufacturer, they're circular.

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They kind of deform into the shape of the actual ulus itself. So in this case,

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it's a little bit more oval in shape.

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You'll see on these post TAVR cts, sometimes they're a little more rounded,

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sometimes a little bit more oval,

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but that's all kind of within the expected range of normal.

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That's about it For these particular devices,

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those are the most common important things to look at in sort of interesting

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features that distinguish these devices.