CT-Guided Transcatheter Aortic Valve Replacement in Bicuspid Aortic Stenosis With a Large Membranous Ventricular Septal Aneurysm: Challenges in Annular Sizing and Valve Selection.
Louay Dandach, Asma Bergaoui, Alaa Masri
✦ AI-curated · Sources linked
Case in brief
A 78-year-old woman with symptomatic severe bicuspid aortic stenosis and a large membranous ventricular septal aneurysm underwent TAVR. Cardiac CT showed that the aneurysmal cavity interrupted annular continuity, making conventional sizing unreliable. A virtual annular plane excluding the aneurysm was used to estimate the effective landing zone (area 387 mm²; perimeter 71.4 mm), informing selection of a 29-mm self-expanding valve. Implantation was successful, with excellent positioning and minimal residual aortic regurgitation. At 2 months, symptoms had markedly improved; CT showed stable valve position, no leaflet thrombosis, and reduced aneurysm systolic volume.
What made this case unusual
The large aneurysm disrupted the apparent annular geometry, creating a specific sizing challenge in a patient who also had bicuspid anatomy and a calcified raphe. CT-based virtual reconstruction provided an alternative estimate of the valve landing zone.
Diagnostic / clinical pearl
When a membranous septal aneurysm interrupts annular continuity, conventional annular measurements may be unreliable; CT-based virtual annular reconstruction can help define the effective TAVR landing zone.