Fig. 24

Planning of the direct aortic approach. Assessment of entire ascending aorta is crucial to exclude the presence of thoracic aneurysm or anterior aortic wall calcifications that might potentially interfere with direct puncture of the aorta. Typically, the aorta is punctured within the most proximal 8.5 cm. a The 3D VR reconstructions of the ascending aorta for assessment of the diameter and presence of anterior aortic wall calcifications. Bone structures provide landmarks for future thoracotomy. Blue line, aortic valve plane; red line, 8.5 cm above the plane of the aortic valve, showing the area of potential direct aortic access. b Magnified view of 3D VR of the ascending aorta with the 8.5-cm landmark, (c) curvilinear reconstruction of the ascending aorta with (d) automatically created perpendicular to (c) the aortic plane with aortic diameter measured at this level