Fig. 7.

Relation between the coronary ostia and the deployed THV. Both self-expandable and balloon-expandable THVs are designed not to obstruct the coronary ostia, with self-expandable Corevalve and Evolut protheses extending into the ascending aorta by design, leaving the coronary ostia open (a, b). When coronary obstruction occurs, it is not by the THV but secondary to displaced calcified native leaflet remnants that migrate during deployment of the THV in the aortic sinus to the vicinity of the coronary ostia. Nevertheless, while CT can detect these migrated calcifications in or near the coronary ostia (c), the evaluation of luminal patency is less obvious, mostly dependent on local expertise and the quality of the CT scanner used