Arriving safely and avoiding a puncture: use of a Radi PressureWire to cross an ATS prosthetic aortic valve for direct measurement of left ventricular pressure.

The direct measurement of left ventricular pressure in the presence of a mechanical aortic valve is a technical challenge for the interventional cardiologist. Direct recording, which is rarely performed, becomes necessary when other imaging methods have failed to evaluate prosthetic valve stenosis or restrictive physiology. Left ventricular pressure has typically been measured after transseptal or direct left ventricular apical puncture.In recent years, investigators have used the 0.014-in coronary Radi PressureWire™ (St. Jude Medical, Inc.; St. Paul, Minn) to cross the St. Jude bileaflet prosthetic aortic valve without the need for puncture. Although another bileaflet aortic valve, the ATS Open Pivot® (ATS Medical, Inc.; Minneapolis, Minn), has an overall design similar to that of the St. Jude valve, the ATS valve has an open-pivot hinge, which has the potential for wire entrapment.Herein, we describe how we successfully measured left ventricular pressure by crossing an ATS Open Pivot prosthetic valve with a Radi PressureWire, in a 60-year-old man in whom pericardial constriction was suspected. The straightforward, uncomplicated procedure enabled confirmation of the diagnosis. We believe that further investigation of this technique is warranted.