State-of-the-Art Review
Aortic Annulus S-Curve: Implications for Transcatheter Aortic Valve Replacement and Related Procedures, Part 1

https://doi.org/10.1016/j.jcin.2022.08.039Get rights and content
Under an Elsevier user license
open archive

Highlights

  • Aortic annulus S-curve and optimal projection aid in guiding TAVR and related procedures.

  • The aim of this manuscript is to present an in-depth insight of aortic annulus S-curve in TAVR.

  • Refinement in C-arm equipment should aim to optimize optimal fluoroscopic projections.

Abstract

Most transcatheter aortic valve replacement–related procedures (eg, transcatheter aortic valve replacement implantation depth, commissural alignment, coronary access, bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction, paravalvular leak closure) require an optimal fluoroscopic viewing angle located somewhere along the aortic annulus S-curve. Chamber views, coronary cusp and coronary anatomy, can be understood along the aortic annulus S-curve. A better understanding of the optimal fluoroscopic viewing angles along the S-curve may translate into increased operator confidence and improved safety and efficacy while reducing procedural time, radiation dose, contrast volume, and complication rates.

Key Words

BASILICA
commissural alignment
coronary access post-TAVR
optimal projection curves
paravalvular leak closure
S-curves

Abbreviations and Acronyms

AP
anteroposterior
BASILICA
bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction
CAUD
caudal
CRAN
cranial
CT
computed tomography
LAO
left anterior oblique
LVOT
left ventricle outflow tract
RAO
right anterior oblique
TAVR
transcatheter aortic valve replacement

Cited by (0)

H. Vernon “Skip” Anderson, MD, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.