[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-148207-en":3,"doc-seo-148207-105":31,"detail-sidebar-cat-0-en-105":92},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":22,"language":23,"language_code":24,"site_id":25,"html_lang":24,"table_of_contents":26,"faqs":27,"seo_title":28,"seo_description":14,"update_tm":29,"read_time":30},148207,13056703019662,"Evangeline","https://ap-avatar.wpscdn.com/avatar/be000253a8e92610077?_k=1778726343310543188",7,"Healthcare","Mind the gap: avoiding paravalvular leak using computer simulation in bicuspid transcatheter aortic valve replacement - a case report","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.","European Heart Journal-Case Reports (2022) 6, 1–6 [https://doi.org/10.1093/ehjcr/ytac398](https://doi.org/10.1093/ehjcr/ytac398)  \nCASE REPORT  \nOther  \nMind the gap: avoiding paravalvular leak using computer simulation in bicuspid transcatheter aortic valve replacement—a case report  \nJames 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  \nReceived 12 April 2022; first decision 11 June 2022; accepted 21 September 2022  \nDown loaded from  \nBackground 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.  \n............................................................................................................................... ..............................................................  \nCase 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.  \n............................................................................................................................... ..............................................................  \nDiscussion Using patient-specific computer simulation, we were able to safely select the valve and the deployment height and then accurately  \npredict 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.  \nKeywords Bicuspid aortic valve • TAVR sizing • Case report  \nESC Curriculum 4. 2 Aortic stenosis • 2.4 Cardiac computed tomography  \n[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  \nLearning points  \n• 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.  \n• There are several accepted methods for valve sizing in BAV: the CASPAR, Circle, LIRA, and BAVARD methods.  \n• 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.  \n* 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  \nPeer-reviewers: Damiano regazzoli-Lancini and Claudio Montalto  \nCompliance Editor: Sara Monosilio  \nSupplementary Material Editor: Jonathan Senior  \n© The Author(s) 2022 . Published by Oxford University Press on behalf of the European Society of Cardiology.  \nThis is an Open","cbCaijr4ypAF2PLL","https://ap.wps.com/l/cbCaijr4ypAF2PLL","pdf",688609,2,1,6,"English","en",105,"# Learning points\n## Accepted methods for valve sizing in BAV\n## Patient-specific pre-procedural modelling vs algorithm-based sizing","[{\"question\":\"为什么在双瓣膜（BAV）患者中TAVR瓣膜尺寸选择更具挑战？\",\"answer\":\"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”。\"},{\"question\":\"文中使用了什么计算模拟方法来辅助决策？\",\"answer\":\"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。\"},{\"question\":\"该病例的主要目的与预期获益是什么？\",\"answer\":\"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。\"}]","Mind the gap: avoiding paravalvular leak using computer simulation in bicuspid transcatheter aortic valve replacement - a case report | PDF",1787777265,15,{"code":4,"msg":32,"data":33},"ok",{"site_id":25,"language":24,"slug":34,"title":13,"keywords":35,"description":14,"schema_data":36,"social_meta":87,"head_meta":89,"extra_data":91,"updated_unix":29},"mind-the-gap-avoiding-paravalvular-leak-using-computer-simulation-in-bicuspid-transcatheter-aortic-valve-replacement-a-case-report","",{"@graph":37,"@context":86},[38,54,69],{"@type":39,"itemListElement":40},"BreadcrumbList",[41,45,48,51],{"item":42,"name":43,"@type":44,"position":21},"https://docshare.wps.com","Home","ListItem",{"item":46,"name":47,"@type":44,"position":20},"https://docshare.wps.com/document/","Document",{"item":49,"name":12,"@type":44,"position":50},"https://docshare.wps.com/document/healthcare/",3,{"item":52,"name":13,"@type":44,"position":53},"https://docshare.wps.com/document/mind-the-gap-avoiding-paravalvular-leak-using-computer-simulation-in-bicuspid-transcatheter-aortic-valve-replacement-a-case-report/148207/",4,{"url":52,"name":13,"@type":55,"author":56,"headline":13,"publisher":58,"fileFormat":61,"inLanguage":24,"description":14,"dateModified":62,"datePublished":63,"encodingFormat":61,"isAccessibleForFree":64,"interactionStatistic":65},"DigitalDocument",{"name":9,"@type":57},"Person",{"url":42,"name":59,"@type":60},"DocShare","Organization","application/pdf","2026-08-31","2026-08-26",true,{"@type":66,"interactionType":67,"userInteractionCount":20},"InteractionCounter",{"@type":68},"ViewAction",{"@type":70,"mainEntity":71},"FAQPage",[72,78,82],{"name":73,"@type":74,"acceptedAnswer":75},"为什么在双瓣膜（BAV）患者中TAVR瓣膜尺寸选择更具挑战？","Question",{"text":76,"@type":77},"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”。","Answer",{"name":79,"@type":74,"acceptedAnswer":80},"文中使用了什么计算模拟方法来辅助决策？",{"text":81,"@type":77},"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。",{"name":83,"@type":74,"acceptedAnswer":84},"该病例的主要目的与预期获益是什么？",{"text":85,"@type":77},"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。","https://schema.org",{"og:url":52,"og:type":88,"og:title":13,"og:site_name":59,"og:description":14},"article",{"robots":90,"canonical":52},"index,follow",{"doc_id":7,"site_id":25},{"code":4,"msg":5,"data":93},[94,98,102,106,111,115,118,123,128,131,135],{"id":21,"doc_module":4,"doc_module_name":47,"category_name":95,"show_sort_weight":96,"slug":97},"Story & Novel",90,"story-novel",{"id":20,"doc_module":4,"doc_module_name":47,"category_name":99,"show_sort_weight":100,"slug":101},"Literature",80,"literature",{"id":53,"doc_module":4,"doc_module_name":47,"category_name":103,"show_sort_weight":104,"slug":105},"Exam",70,"exam",{"id":107,"doc_module":4,"doc_module_name":47,"category_name":108,"show_sort_weight":109,"slug":110},5,"Comic",60,"comic",{"id":22,"doc_module":4,"doc_module_name":47,"category_name":112,"show_sort_weight":113,"slug":114},"Technology",50,"technology",{"id":11,"doc_module":4,"doc_module_name":47,"category_name":12,"show_sort_weight":116,"slug":117},40,"healthcare",{"id":119,"doc_module":4,"doc_module_name":47,"category_name":120,"show_sort_weight":121,"slug":122},8,"Research & Report",30,"research-report",{"id":124,"doc_module":4,"doc_module_name":47,"category_name":125,"show_sort_weight":126,"slug":127},9,"Religion & Spirituality",20,"religion-spirituality",{"id":126,"doc_module":4,"doc_module_name":47,"category_name":129,"show_sort_weight":126,"slug":130},"World Cup","world-cup",{"id":132,"doc_module":4,"doc_module_name":47,"category_name":133,"show_sort_weight":132,"slug":134},10,"Lifestyle","lifestyle",{"id":136,"doc_module":4,"doc_module_name":47,"category_name":137,"show_sort_weight":107,"slug":138},19,"General","general"]