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Figure 3 TEE-Guided PHV Positioning and Deployment
Good awareness of the echocardiographic appearance of the undeployed PHV (stent) and its relation to the deployment catheter and balloon is critical to correct device positioning. (A) Transesophageal echocardiography long-axis view showing satisfactory stent position before deployment. The undeployed PHV is identified as an echogenic rectangular structure, which is seen in contrast to the larger and less echodense balloon. The ventricular (red arrow) and aortic (yellow arrow) ends of the stent are indicated in relation to the native aortic valve (blue arrow). Online Video 1 shows the ideal position for the stented PHV prior to deployment. (B) Long-axis view at the moment of balloon deployment of the PHV. The blue arrowheads indicate the balloon and yellow arrows the prosthesis. Online Video 2 shows deployment of the PHV by rapid balloon inflation. The final appearance of the deployed PHV is seen in panel C. The yellow arrows indicate the stent and the white arrow the prosthetic valve leaflet. The fully deployed PHV is shown in the short-axis view in Online Video 3. Online Video 4 shows imaging of the deployed prosthesis in the long-axis view. The prosthesis is in good position and no aortic regurgitation is seen. Abbreviations as in Figure 1.
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