Fluoroscopy use and left anterior descending artery angiography to guide transapical access in patients with prior cardiac surgery




Background


Patients with severe aortic stenosis (AS) and prior cardiac surgery undergoing aortic valve replacement (AVR) are at high risk. We aimed to describe the fluoroscopy and left anterior descending (LAD) artery angiography guidance technique for transapical AVR access and the related procedural results.




Methods


Patients with severe AS and prior cardiac surgery undergoing transapical AVR using LAD-angiographic guided apical puncture were analyzed ( n =9). Additional guidance was added to the standard technique as follows. Mini-thoracotomy was performed at the level of the intercostal space in closer relationship to the apex identified by fluoroscopy. LAD angiography was performed at the time that the area of interest was recognized by radiopaque mark to ensure puncture lateral to the LAD ( Fig. 1 ). Apical needle puncture was performed under fluoroscopy guidance directed towards the aortic root.




Fig. 1


Left anterior descending artery angiograms for apical puncture guidance. Avoidance of LAD artery injury by angiographic guidance of apical site puncture. Forceps are pointed by arrows; location lateral to the LAD visualized from a left mammary internal artery graft (A), saphenous vein graft (B), and native left coronary artery (C).

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Nov 16, 2017 | Posted by in CARDIOLOGY | Comments Off on Fluoroscopy use and left anterior descending artery angiography to guide transapical access in patients with prior cardiac surgery

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