Case Report: Patient-specific three-dimensional printing and computational fluid dynamics in the planning of transcatheter aortic valve replacement for quadricuspid aortic valve.

Abstract

<h4>Background</h4>Performing transcatheter aortic valve replacement (TAVR) in patients with high-risk quadricuspid aortic valve (QAV) may be feasible, but uncertainties remain regarding the development of a comprehensive procedural plan and predicting the outcomes.<h4>Case summary</h4>We report a case of a 70-year-old patient with a high-risk (EuroSCORE II: 11.2%) QAV (type B) and severe aortic regurgitation (regurgitant jet area measuring 9.8 cm²). To avoid high-risk surgery, we selected a 29-mm J-Valve for the transapical TAVR without the occurrence of paravalvular leak based on a patient-specific 3D printed model. Computational fluid dynamics simulations were performed to evaluate the hemodynamic parameters pre- and post-TAVR and showed that the trans-aortic valve pressure gradient decreased from 4.7 mmHg to 3.5 mmHg, the peak trans-aortic velocity decreased from 1.02 m/s to 0.89 m/s, and the low wall shear stress area was increased from 18.92 cm² to 19.15 cm². These findings suggest the effectiveness of the TAVR procedure. Based on the simulation results, the procedure was successfully implemented, leading to an improvement in the patient's clinical status.<h4>Conclusion</h4>Three-dimensional printing and computational fluid dynamics simulations may be valuable tools for planning, assessing procedural outcomes, and evaluating risks in TAVR procedures for patients with QAV.