Toolbox: Catheter Selection

Angiogram

Self-Expanding Valve

Commissural Post Front

Left System

• The self-expanding valve has a concave central portion (20-24 mm) which is narrower than native aortic root dimensions.
• Use smaller catheter: JL3.5 (femoral approach) or a JL3 (radial approach) for left system. Can also use JR4 to engage LCA.
• If unable to engage, perform non-selective angiogram.
• Second line: Use guide catheter (Ikari Right 1.0/1.5 or FL3.0).
• Use guide catheter such as Ikari Right or FL 3.0 with a coronary guidewire to wire coronary artery for more selective engagement.

Right System

• Use JR4 catheter.
• If not able to selectively engage, perform non-selective angiogram +/- aortogram.
• Second line: consider using guide catheter such as Ikari Right 1.5 or Multipurpose (MP).
• Use coronary guidewire for more selective engagement if needed.
• Use guide catheter such as Ikari Right or MP with a coronary guidewire to wire coronary artery for more selective engagement.

Commissural Post Away

Left System

• Use JL3.5 or JR4.
• Second Line: use catheter like Ikari Right 1.0/1.5.
• If the skirt is high, catheters such as FR4 or Ikari Right 1.0/1.5 can be used to enter
  from the diamond above the coronary ostia.

Right System

• Use a standard catheter like JR3.5 or JR4.
• Use AR2 catheter as the second line, especially if sinuses are wide.
• If the skirt is high, use MP guide to enter from the diamond above coronary ostia.