Images in cardiovascular medicine. Direct endoscopic visual assessment of a transcatheter aortic valve implantation and performance in the Physioheart, an isolated working heart platform.

Transcatheter aortic valve implantation (TAVI) is an increasingly considered option to treat aortic stenosis in patients with a high operative risk. Valve placement during the procedure is typically guided by angiography and/or echocardiography, whereas these techniques are also used to judge valvular function. More detailed postprocedure visualization may be obtained with 3-dimensional echocardiography or magnetic resonance imaging. These imaging methods appear to be adequate for clinical assessment of TAVI, but direct optical visualization with high temporal and spatial resolution would be advantageous to study the details of this new procedure. The working heart model as described by Chinchoy et al1 enables direct intracardiac endoscopy,2 which provides unique insights into the form, function, and physiology of the heart. We applied this approach to study the placement and performance …