Integrated 3D Echo-X-Ray navigation to predict optimal angiographic deployment projections for TAVR.

(A) The integrated marking feature allows for the placement of a colored are placed on or near the center of each of the coronary cusps in the en colored markers are individually dragged (table side control, using a stand level of the aortic annulus (left panel). These 2 separate steps result in the (long-axis location) of each coronary cusp of the native aortic valve. (C) to a position such that the 3 colored markers (corresponding to the appr (noncoronary cusp [NCC], right coronary cusp [RCC], and left coronary cu fluoroscopy (in this case a left anterior oblique 7, caudal 4 projection). (D) for the x-ray gantry determined by coplanar marker alignment (white lin angiographic deployment view for use during TAVR. (E) Immediately after alignment to the aortic annulus while the final valve orientation confirms mark (C to E) depicts the head of the transesophageal echocardiography p the 3-dimensional (3D) aortic annulus is a critical component of a successful TAVR procedure. Improper positioning of the prosthetic valve (e.g., too high or too low in the annulus) may result in device embolization, coronary obstruction, or paravalvular leak. Proper valve positioning is best achieved by working in a 2-dimensional x-ray fluoroscopic view that is perpendicular to the native valve/annulus (e.g., the “coplanar view”). Various imaging techniques and modalities, including standard aortic root x-ray angiography, multidetector computed tomography, and 3D angiographic reconstructions of the aortic root generated by rotational C-arm x-ray angiography,