syngo DynaCT - Aortic Valve Implantation
81-year-old female patient with high-grade aortic stenosis and increased operative risk.
The patient suffered from aortic valve stenosis, pulmonary hypertension and respiratory dysfunction. In addition she had arterial hypertension, chronic atrial fibrillation and diabetes mellitus.
Patient under general anesthesia. Insertion of a right femoral arterial sheath and a right femoral venous guidewire for potential insertion of cannulas for cardiopulmonary bypass (safety net). Insertion of a pigtail catheter through the femoral sheath into the aortic root.
Left anterolateral minithoracotomy in the fifth intercostal space and opening of the pericardium at the apex of the left ventricle. Placement of an epicardial pacemaker lead and of two apical purse-string sutures. Conduction of the syngo DynaCT under rapid ventricular pacing with injection of diluted (1:3) contrast into the aortic root. Calculation of the 3D volume and initiation of an overlay mode. Angulation of the C-arm in an exactly orthogonal position guided by the results of the syngo DynaCT. At the beginning of valve implantation puncture of the apex, antegrade placement of a soft guidewire across the stenosed aortic valve and placement of a 14 F sheath into the ascending aorta.
Placement of a super-stiff guidewire into the descending aorta. In parallel preparation of the Edwards SAPIEN aortic bioprosthesis, size 23 mm. Insertion of a 20 mm balloon catheter and balloon dilatation of the native and stenosed aortic valve during a brief episode of rapid ventricular pacing. Exchange to a 26 F application sheath, attachment, deairing and positioning of the valve. Positional control by angiography and by the syngo DynaCT overlay in addition. Valve implantation during a second episode of rapid pacing. No relevant insufficiency was detected by angiography or echocardiography. Removal of the guidewire and the sheath and closure of the apical incision. Removal of the femoral wire and sheath. The whole implantation was performed on a beating heart and instantaneously good function of the implanted valve was obtained.
120 ml contrast media
8 min fluoroscopy
Pre- and post-operative syngo DynaCT runs
Implantation of syngo iPilot for a three-dimensional overlay
Rotational angiographic scan with syngo DynaCT. 20 ml contrast media (diluted with sodium chloride 1:3) injected via pigtail catheter into the aortic root, followed by a 5 sec syngo DynaCT run under rapid ventricular pacing.
Single slices of a syngo DynaCT 3D reconstruction (axial MPRs).
Interactive segmentation of the aortic root and coronary ostia in 3D syngo DynaCT volume.
Selection of optimal C-arm angulation for the procedure by using three-dimensional image information. syngo iPilot is used for overlay of live fluoro image with syngo DynaCT 3D volume.
Balloon dilatation for aortic valvuloplasty supported by syngo iPilot super-imposition.
Aortic valve deployment is performed and was supported by syngo iPilot overlay.