Optimal angulations of the X-ray tubes parallel to the plane of the aortic valve is needed for successful percutaneous aortic valve implantation (PAVI). Finding the ideal plane with fluoroscopy requests several injections of contrast medium and prolongs the radiation time and the duration of the procedure. This case report describes the use of multi-detector computed tomographic angiography (MDCTA) for defining the optimal fluoroscopic projections to facilitate valve implantation.
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In patients with Ebstein's disease, an atrial septum defect (ASD) may be present which may unload the (failing) right ventricle. This may be at the expense of arterial desaturation due to the reversal of the existing left-right shunt, which may occur already at rest or during episodes of increased stress such as exercise. The treatment of these patients is in principle surgical correction of both the ASD and tricuspid valve, since isolated (percutaneous) closure of the ASD takes away the low pressure escape route of the right ventricle. We report a patient who was initially rejected for percutaneous closure of the ASD because of this presumed pathophysiologic condition. In present report, we describe the haemodynamic assessment and evaluation of the appropriateness of isolated percutaneous closure of the ASD.
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