Mind the gap: avoiding paravalvular leak using computer simulation in bicuspid transcatheter aortic valve replacement - a case report

Aug 26, 2026

Transcatheter aortic valve replacement (TAVR) is expanding globally, with bicuspid aortic valve (BAV) patients representing a substantial and anatomically complex subgroup. Because BAV has heterogeneous morphology, valve sizing based on CT-derived annular measurements can yield conflicting results, particularly in the grey zone between valve sizes. This case report describes pre-procedural patient-specific finite-element simulation using the Medtronic Evolut PRO+ platform to support safe sizing, deployment height selection, and outcome prediction in a severely calcified BAV case, facilitating tailored heart-team discussion.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Learning points

Accepted methods for valve sizing in BAV

Patient-specific pre-procedural modelling vs algorithm-based sizing

European Heart Journal-Case Reports (2022) 6, 1–6 [https://doi.org/10.1093/ehjcr/ytac398](https://doi.org/10.1093/ehjcr/ytac398) CASE REPORT Other Mind the gap: avoiding paravalvular leak using computer simulation in bicuspid transcatheter aortic valve replacement—a case report James Dargan 1, Rumneek Hampal2, Faisal Khan2, and Stephen Brecker 1* 1Cardiovascular Clinical Academic Group, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK; and 2St George’s University Hospitals NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, UK Received 12 April 2022; first decision 11 June 2022; accepted 21 September 2022 Down loaded from Background Transcatheter aortic valve replacement (TAVR) is becoming increasingly prevalent worldwide and is now more common than surgical aortic valve replacement. It is expanding into all patient subsets including younger and lower risk patients. Bicuspid aortic valve (BAV) accounts for a signiﬁcant proportion of TAVR, but due to heterogenous anatomy, it is of increased complexity. One of the greatest challenges in BAV is the selection of the correct TAVR size. Transcatheter aortic valve replacement sizing is based upon computed tomography–derived annular measurements. There are a number of sizing algorithms for BAV based upon anatomical characteristics, often yielding different results. This is noted especially when a patient falls near the borderline between two valve sizes, an anatomical grey zone. Complementary to the algorithm approach is the use of pre-procedural patient-speciﬁc computer simulation using ﬁnite-element modelling. ............................................................................................................................... .............................................................. Case summary An 86-year-old female was treated for heart failure secondary to severe and calciﬁc BAV aortic stenosis with TAVR. Due to anatomical difﬁculty and grey-zone valve sizing, we demonstrate the use of pre-procedural patient-speciﬁc computer simulation with the novel Medtronic Evolut PRO+ platform to achieve a good result. ............................................................................................................................... .............................................................. Discussion Using patient-speciﬁc computer simulation, we were able to safely select the valve and the deployment height and then accurately predict the result in a difﬁcult, severely calciﬁed BAV. In addition to improving outcome, this allows for patient-speciﬁc, tailored discussion to occur at heart team meetings. Keywords Bicuspid aortic valve • TAVR sizing • Case report ESC Curriculum 4. 2 Aortic stenosis • 2.4 Cardiac computed tomography [https://academic.oup.com/ehjcr/article/6/10/ytac398/6726538 by guest on](https://academic.oup.com/ehjcr/article/6/10/ytac398/6726538 by guest on) 15 Learning points • Transcatheter bicuspid aortic valve (BAV) intervention is an expanding and challenging ﬁeld. Determining the correct valve size is integral in ensuring a good outcome. Patient-speciﬁc simulation modelling can assist in this. • There are several accepted methods for valve sizing in BAV: the CASPAR, Circle, LIRA, and BAVARD methods. • We demonstrate the use of patient-speciﬁc pre-procedural modelling which may have advantages over algorithm-based methodology to achieve the best result in an individual patient. * Corresponding author. Tel: +44 20 8725 3556, Fax: +44 20 8725 0211, Email: [sbrecker@sgul.ac.uk](sbrecker@sgul.ac.uk)[ ](sbrecker@sgul.ac.uk)Handling Editor: Francesco Moroni Peer-reviewers: Damiano regazzoli-Lancini and Claudio Montalto Compliance Editor: Sara Monosilio Supplementary Material Editor: Jonathan Senior © The Author(s) 2022 . Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open

FAQs

为什么在双瓣膜（BAV）患者中TAVR瓣膜尺寸选择更具挑战？

BAV解剖结构异质性较强，基于CT环形测量的不同尺寸算法可能给出相互矛盾的结果，尤其是在两种型号尺寸的临界“灰区”。

文中使用了什么计算模拟方法来辅助决策？

在术前进行基于患者特异性的计算机模拟，并采用有限元建模。

该病例的主要目的与预期获益是什么？

通过模拟来安全选择瓣膜型号和释放深度，并更准确预测难治性、重度钙化BAV的结果，从而改善结局并支持心脏团队会议中的个体化讨论。

Aug 26, 2026

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