Valve Engagement: Angiography

[{"time":"00:00:00","description":"Low coronary height in combination with high implantation of balloon expandable valve can lead to valve struts facing the coronaries and poses challenge during catheter engagement."},{"time":"00:00:04","description":"J-wire can help reaching at the valve inflow area."},{"time":"00:00:06","description":"If J-wire falls behind the valve struts, redirect it to valve inflow area with the help of catheter."},{"time":"00:00:10","description":"Advance a JR4 catheter over the J-wire to reach the valve inflow area."},{"time":"00:00:13","description":"J-wire can be removed at this point as it would not be helpful in crossing valve struts."},{"time":"00:00:15","description":"Torque the catheter clockwise to bring its tip towards the right coronary sinus."},{"time":"00:00:17","description":"Stiff angled glide wire can be used to cross the specific valve strut diamond (typically first row of wider diamonds) located in front of the right coronary ostium."},{"time":"00:00:23","description":"Catheter can be railed over the glide wire and wire can be removed."},{"time":"00:00:27","description":"Catheter can be advanced to engage right coronary ostium."},{"time":"00:00:29","description":"After completion of angiography, disengage the catheter."},{"time":"00:00:31","description":"Keep the distal end of the catheter in the right coronary sinus beyond the valve struts."},{"time":"00:00:33","description":"J-wire should be advanced enough that its tip conforms the J shape."},{"time":"00:00:34","description":"Rail back the catheter over J-wire back in the valve inflow."},{"time":"00:00:35","description":"Now bring the J-wire back in the valve inflow."},{"time":"00:00:37","description":"Remove catheter and J-wire as an assembly together."}]