COMMISSURE MARKER FOR A PROSTHETIC HEART VALVE

Abstract

Methods and systems are described for attaching a radiopaque marker to a prosthetic heart valve to indicate the location of a prosthetic heart valve commissure. As one modality, a prosthetic heart valve may include a frame comprising a plurality of struts forming a plurality of frame cells arranged between an inlet end and an outlet end of the frame, a plurality of leaflets arranged within the frame, at least one commissure comprising a connecting member arranged across a selected cell from the plurality of frame cells and attached to the frame struts forming the selected cell, and the commissure tabs of two adjacent leaflets coupled to the connecting member, and a radiopaque marker disposed on the commissure connecting member. The marker is configured to indicate a prosthetic heart valve commissure location.

Description

COMMISURE MARKER FOR A PROSTHETIC HEART VALVE Field of Invention The present disclosure relates to prosthetic heart valves and markers for prosthetic heart valves configured to indicate a location of a commissure of the prosthetic heart valve. Background of the Invention The human heart can suffer from various valve diseases. These valvular diseases can result in significant malfunction of the heart and ultimately require repair of the native valve or replacement of the native valve with an artificial valve. There are a number of known repair devices (e.g., stents) and artificial valves, as well as a number of known methods for implanting these devices and valves in humans. Percutaneous and minimally invasive surgical approaches are used in various procedures to deliver prosthetic medical devices to locations within the body that are not easily accessible by surgery or where non-surgical access is desirable. In a specific example, a prosthetic heart valve may be mounted in a crimped state at the distal end of a delivery device and advanced through the vasculature of the patient (e.g. Ref. 342850 through a femoral artery and the aorta) until the prosthetic valve reaches the implantation site in the heart. The prosthetic valve is then expanded to its functional size, for example, by inflating a balloon on which the prosthetic valve is mounted. When the prosthetic valve is deployed on the native valve (for example, by inflating the balloon of the delivery device), the radially expanded prosthetic valve is deployed in a random radial orientation relative to the native valve. As such, in some embodiments, one of the commissures of the prosthetic valve may be disposed in front of (e.g., adjacent to) a coronary ostium of the aorta. This arrangement may reduce coronary access (e.g., blood flow to the coronary arteries from the aorta) and / or create difficulties during future cardiovascular interventions that help maintain or increase coronary access. Additionally, after implanting a prosthetic heart valve, it may be desirable to confirm a location of the commissures of the prosthetic heart valve relative to the commissures of the native heart valve. Accordingly, there is a need to improve prosthetic heart valve configurations that allow identification of a position of one or more commissures of the prosthetic heart valve during an implantation procedure and / or after implantation into a native heart valve. Summary of the Invention Disclosed herein are embodiments of prosthetic heart valves that include one or more radiopaque markers placed on or near a commissure of the prosthetic heart valve. As a result, a location of a selected commissure of the prosthetic valve can be identified by obtaining medical images during a valve implantation procedure and / or after implanting the prosthetic heart valve into a native heart valve. In a representative embodiment, a prosthetic heart valve comprises a frame that includes a plurality of struts forming a plurality of frame cells disposed between an inlet end and an outlet end of the frame; a plurality of leaflets disposed within the frame; at least one commissure including a joint member disposed across a cell selected from the plurality of cells of the frame and attached to the struts of the frame that form the selected cell, and the commissure tabs of two adjacent leaflets coupled to the member of Union; and a radiopaque marker disposed in the commissure attachment member, the marker being configured to indicate a location of the commissure of the prosthetic heart valve. In another representative embodiment, a prosthetic heart valve comprises a frame that includes a plurality of struts forming a plurality of frame cells disposed between an inlet end and an outlet end of the frame; a plurality of leaflets disposed within the frame; at least one commissure comprising a first attachment member disposed across a cell selected from the plurality of cells of the frame and attached to the struts of the frame forming the selected cell, and the commissure tabs of two adjacent leaflets coupled to the first union member; and a radiopaque marker attached to a second attachment member, the second attachment member disposed across the selected cell and attached to the struts forming the selected cell, the second attachment member disposed outside the first attachment member relative to a central longitudinal axis of the frame. The marker is configured to indicate a location of the commissure of the prosthetic heart valve. In another representative embodiment, a prosthetic heart valve comprises a frame that includes a plurality of struts forming a plurality of frame cells disposed between an inlet end and an outlet end of the frame; a plurality of leaflets disposed within the frame; at least one commissure comprising commissure tabs of two adjacent leaflets of the plurality of leaflets connected to each other, the at least one commissure secured to the frame struts forming a cell selected from the plurality of cells; and a radiopaque marker attached to a binding member, the binding member disposed across the selected cell and attached to the struts forming the selected cell. The marker is configured to indicate a location of the commissure of the prosthetic heart valve. The above and other objects, features, and advantages of the described technology will become more apparent from the following detailed description, which continues with reference to the accompanying figures. Brief Description of the Figures Figure 1 is a perspective view of a prosthetic heart valve, according to one embodiment. Figure 2A is a perspective view of a prosthetic heart valve, according to another embodiment. Figure 2B is a perspective view of the prosthetic valve of Figure 2A with the components on the outside of the frame shown in transparent lines for purposes of illustration. Figure 3 is a perspective view of a delivery apparatus for a prosthetic heart valve, according to one embodiment. Figure 4 is a diagram of an illustrative heart showing a position of the coronary arteries in relation to an aortic valve. Figure 5A illustrates an illustrative positioning of a prosthetic valve in an aortic valve, relative to a coronary artery. Figure 5B illustrates another illustrative positioning of a prosthetic valve in an aortic valve, relative to a coronary artery, where the prosthetic valve at least partially inhibits blood flow to the coronary artery. Figure 6A is a cross-sectional view of an aortic valve illustrating a first positioning of a prosthetic valve within the aortic valve where the commissures of the prosthetic valve at least partially block one or more openings to the coronary arteries. Figure 6B is a cross-sectional view of an aortic valve illustrating a second positioning of a prosthetic valve within the aortic valve where the commissures of the prosthetic valve align circumferentially with the native commissure of the aortic valve, which maintains This way access to the coronary arteries. Figure 7 illustrates a leaflet cutting procedure where a leaflet of a native aortic valve can be divided at a location of an inlet to a coronary artery when a prosthetic heart valve is implanted within the aortic valve to allow greater blood flow to enter. the coronary artery. Figure 8A illustrates an illustrative prosthetic heart valve and an example of how dividing a native leaflet surrounding the prosthetic heart valve in a region of a frame of the prosthetic heart valve that is between two adjacent commissures results in open cells in front of an inlet. to a coronary artery. Figure 8B illustrates the illustrative prosthetic heart valve of Figure 8A and how dividing the native leaflet into a region of the prosthetic heart valve frame that includes a commissure does not result in open cells being arranged in front of the entrance to the coronary artery. . Figure 9 is a side view of one embodiment of a delivery apparatus configured to deliver and implant a radially expandable prosthetic heart valve at an implantation site. Figure 10 is a cross-sectional side view of a distal end portion of the delivery apparatus of Figure 9. Figure 11 is a side view of the distal end portion of the delivery apparatus of Figure 9, illustrating a distal tip portion of an outer shaft of the delivery apparatus. Figure 12 is a schematic view of one embodiment of an intermediate shaft of the delivery apparatus of Figure 9. Figure 13 is a cross-sectional side view of a detailed portion of the coaxial shafts of the delivery apparatus of Figure 11. Figure 14 is a cross-sectional side view of a handle of the delivery apparatus of Figure 9. Figure 15 is a first perspective view of an embodiment of a rotating knob mounted on a proximal end portion of an intermediate shaft of a delivery apparatus, the knob configured to rotate the intermediate shaft, thereby rotating a balloon unreliable and a prosthetic heart valve radially compressed on the balloon. Figure 16 is a second perspective view of the knob of Figure 15. Figure 17 is a cross-sectional side view of the knob of Figure 15. Figure 18 is a cross-sectional view of an anchor of the knob of Figure 15, the anchor configured to couple the knob to the intermediate shaft. Figure 19 is a perspective view of the anchor of Figure 18. Figure 20 is an exploded view of an outer casing of the knob of Figure 15. Figure 21 is a side view of the anchor of Figure 18, mounted on the proximal end portion of the intermediate shaft. Figure 22 is a side view of the knob of Figure 15, mounted on the proximal end portion of the intermediate shaft with a housing portion of the outer housing removed to show the anchor. Figure 23 is a perspective view of one embodiment of a proximal end portion of a delivery apparatus, including a handle, a rotating knob, and an adapter. Figure 24 is a perspective view of the adapter in Figure 23, the adapter comprising a first port and a second port that is configured to rotate relative to the adapter body and the first port. Figure 25 is a cross-sectional view of the adapter of Figure 24. Figure 26 is a cross-sectional view of the adapter of Figure 24, mounted on the proximal end portion of the delivery apparatus. Figure 27 is a detailed cross-sectional view of a portion of the adapter of Figure 2-6 that includes a rotating interface between the second port and the adapter body. Figure 28 illustrates a side view of a distal end portion of a delivery apparatus with an illustrative radiopaque marker placed in and / or incorporated within a polymeric body of the distal end portion of the delivery apparatus. Figure 29 illustrates an illustrative fluoroscopic image of the distal end portion of the delivery apparatus, including the radiopaque marker, of Figure 28. Figure 30 illustrates an embodiment of an asymmetric radiopaque marker that allows a user to differentiate between two different positions of the marker within an imaging view. Figure 31A is an illustrative fluoroscopic image illustrating a guide extending through a distal end portion of a delivery apparatus and the asymmetric marker of Figure 30 disposed in or incorporated within a portion of the distal end portion of the supply device and in a first orientation in relation to the guide. Figure 31B is an illustrative fluoroscopic image illustrating a guide extending through a distal end portion of a delivery apparatus and the asymmetric marker of Figure 30 disposed in or incorporated within a portion of the distal end portion of the supply apparatus and in a second orientation in relation to the guide. Figure 32A shows a side view of an illustrative delivery apparatus with the asymmetrical marker of Figure 30 disposed at or incorporated within a distal flange of the delivery apparatus. Figure 32B is a perspective view of the illustrative delivery apparatus of Figure 32A with the asymmetric marker of Figure 30 disposed on or incorporated within the distal flange of the delivery apparatus. Figure 33 illustrates another embodiment of an asymmetric radiopaque marker that allows a user to differentiate between two different positions of the marker within an imaging view. Figure 34A is an illustrative fluoroscopic image illustrating a guide extending through a distal end portion of a delivery apparatus and the asymmetric marker of Figure 33 disposed in or incorporated within a portion of the distal end portion of the supply device and in a first orientation in relation to the guide. Figure 34B is an illustrative fluoroscopic image illustrating a guide extending through a distal end portion of a delivery apparatus and the asymmetric marker of Figure 33 disposed in or incorporated within a portion of the distal end portion of the supply apparatus and in a second orientation in relation to the guide. Figure 35A illustrates an illustrative embodiment of a radiopaque marker attached to a commissure of a prosthetic valve, the prosthetic valve in a radially compressed configuration. Figure 35B illustrates the prosthetic valve of Figure 35A in a radially expanded configuration. Figure 35C illustrates an illustrative prosthetic heart valve with a first attachment member disposed across a cell of the prosthetic heart valve and secured to struts forming the cell, and a radiopaque marker secured to a second attachment member that is configured to join the struts forming the cell, where the commissure tabs of the adjacent leaflets of the prosthetic heart valve are secured to the first attachment member to form a commissure Figures 35D-35F illustrate the first attachment member and the second attachment member that are attached to the struts forming the cell at the same time with the same sutures. Figure 35G illustrates the marker of Figure 35C, attached to the second connection member that joins the struts that form the prosthetic valve cell, in front of the first connection member of the commissure. Figure 35H illustrates an inner surface of the commissure and the first attachment member attached to the prosthetic valve cell. Figure 351 illustrates an illustrative radiopaque marker configured to attach to a commissure within a cell of a prosthetic valve. Figure 35J illustrates another illustrative embodiment of a radiopaque marker attached to a commissure within a cell of a prosthetic valve. Figure 35K illustrates another illustrative embodiment of a radiopaque marker attached to a commissure within a cell of a prosthetic valve. Figure 35L illustrates another illustrative embodiment of a radiopaque marker attached to a commissure within a cell of a prosthetic valve and a radiopaque marker attached to a skirt extending across an inner surface of a frame of the prosthetic valve, directly beyond below the commissure. Figure 35M illustrates another illustrative embodiment of a radiopaque marker attached to a commissure within a cell of a prosthetic valve, the prosthetic valve in a radially compressed configuration. Figure 35N illustrates another illustrative embodiment of a radiopaque marker attached to a commissure within a cell of a prosthetic valve, the prosthetic valve in a radially compressed configuration. Figure 350 illustrates an illustrative embodiment of a radiopaque marker attached to a first attachment member, the first attachment member attached to a second attachment member of a commissure within a cell of a prosthetic valve. Figure 35P illustrates another illustrative embodiment of a radiopaque marker attached to a first attachment member, the first attachment member attached to a second attachment member of a commissure within a cell of a prosthetic valve. Figure 36 illustrates one embodiment of an inflatable balloon folded around a distal end portion of a delivery apparatus. Figure 37 is a cross-sectional view of an unreliable balloon wrapped and folded around a portion of a delivery apparatus, in a valve mounting portion of the delivery apparatus, according to one embodiment. Figure 38 is a perspective view of one embodiment of a distal tip portion for an outer shaft of a delivery apparatus that includes a plurality of internal helical expansion slots. Figure 39 is a cross-sectional view of the distal tip portion of Figure 38 mounted on a distal end of the outer shaft and disposed on a non-reliable balloon portion of the delivery apparatus. Figure 40 is a side view of a distal end portion of the delivery apparatus illustrating a radial depression in a distal end portion of an inflatable balloon of the delivery apparatus, when the distal tip portion is disposed away from a portion of the proximal end of the globe. Figure 41 is a side view of the distal end portion of the delivery apparatus of Figure 40, illustrating a state of the distal end portion of the inflatable balloon when the distal tip portion is disposed over the proximal end portion of the balloon and a prosthetic valve is mounted on a valve mounting portion of the delivery apparatus. Figure 42 is a side view of a distal end portion of an illustrative delivery apparatus with a prosthetic valve mounted on and around a valve mounting portion of the distal end portion of the delivery apparatus, in a radially compressed, with a selected commissure of the prosthetic valve circumferentially displaced from a radiopaque marker in the delivery apparatus by a predetermined amount. Figure 43 is a rear perspective view of an illustrative embodiment of a crimping device configured to crimp a prosthetic valve on a portion of a delivery apparatus. Figure 44 is a front perspective view of the curling device of Figure 43. Figure 45 is a perspective view of one embodiment of a support body for a mounting assembly configured to mount and crimp a prosthetic valve onto a delivery apparatus in a predetermined position and / or orientation relative to the delivery apparatus, the support body configured to contain the prosthetic valve in a radially expanded state. Figure 46 is a front perspective view of one embodiment of a ring body configured to engage the support body of Figure 45 and circumferentially align the prosthetic valve on the support body in a desired orientation. Figure 47 is a rear perspective view of the ring body of Figure 46. Figure 48 is a perspective view of the ring body of Figure 46 engaged with the support body of Figure 45. Figure 49 is a perspective view of one embodiment of a positioning device of a mounting assembly, coupled to a portion of the distal end of a delivery apparatus. Figure 50 is a rear view of a prosthetic valve mounted on the support body of Figure 45, with the commissure aligned with the corresponding indicators on the ring body of Figure 46. Figure 51 is a cross-sectional view of the mounting assembly, including the support body of Figure 45 and the positioning device of Figure 49, coupled and arranged within the curling device of Figure 43 so that the Prosthetic valve is arranged in a predetermined orientation and / or position around a valve mounting portion of a distal end portion of the delivery apparatus, relative to the delivery apparatus. Figure 52 is a cross-sectional view of the prosthetic valve radially compressed onto the valve mounting portion of the delivery apparatus after performing a curling operation with the curling device of Figure 43. Figure 53 is a perspective view of another embodiment of a positioning device that can be used in a mounting assembly and coupled to a curling device. Figure 54 is a side view of the positioning device of Figure 53 coupled to a distal end portion of a delivery apparatus, proximal to a mounting portion of the valve. Figure 55 is a perspective view of the positioning device of Figure 53 attached to the distal end portion of the delivery apparatus of Figure 54. Figure 56 is a flow chart of an illustrative method for crimping a prosthetic valve in a radially compressed state over a distal end portion of a delivery apparatus, in a predetermined position and in a predetermined orientation relative to the delivery apparatus. Figure 57 is a flow chart of an illustrative method for implanting a prosthetic valve into a native valve of a patient with one or more selected commissures of the prosthetic valve in alignment with one or more corresponding commissures of the native valve. Figure 58 illustrates an illustrative fluoroscopic image of a native valve viewed with a standard, three-cusp imaging view. Figure 59 illustrates an illustrative fluoroscopic image of a portion of the distal end of a delivery apparatus that includes an asymmetric radiopaque marker, where the marker is centered along a guide extending through the delivery apparatus and appears in a readable forward orientation, thereby indicating that the marker is in a direct rear portion of the imaging view. Figure 60 is a schematic illustrating a desired rotary positioning of a distal end portion of a delivery apparatus, including a prosthetic valve mounted thereon, on a native valve with an asymmetric radiopaque marker of the delivery apparatus aligned with a target commissure of the native valve and a selected commissure of the prosthetic valve circumferentially displaced from the marker by a predetermined amount. Figure 61 is a schematic of one embodiment of a three-cusp imaging view of a native valve that can be used to visualize a delivery apparatus in a patient's heart during an implantation procedure and rotatably align a mounted prosthetic valve. in the supply apparatus. Figure 62 is a cross-sectional view of a native valve, illustrating a location of the commissures of the native valve within the image view of Figure 61. Figure 63 is a schematic of one embodiment of a right / left cusp overlay imaging view of a native valve that can be used to visualize a delivery apparatus in a patient's heart during an implantation procedure and rotatably align a prosthetic valve mounted on the delivery apparatus. Figure 64 is a cross-sectional view of a native valve, illustrating a location of the commissures of the native valve within the image view of Figure 63. Figure 65 illustrates one embodiment of an alignment ring configured to rotatably align a prosthetic valve relative to a delivery apparatus for an implantation procedure using a first view image. Figure 66 illustrates another embodiment of an alignment ring configured to rotatably align a prosthetic valve relative to a delivery apparatus for an implantation procedure using a second view image. Figure 67 illustrates another embodiment of an alignment ring that includes multiple sets of alignment markers for use in two or more implantation procedures that use differently selected image views. Figure 68 illustrates another embodiment of an alignment ring that includes one or more sets of graduated alignment markers. Figure 69 is an exploded view of one embodiment of a balloon overlay for a distal end portion of the delivery apparatus that is configured to overlay an unreliable balloon and a positioning device mounted on the distal end portion. Figure 70 is a perspective view of a balloon skin cover member of Figure 60, the cover member configured to engage another balloon skin cover member to form an outer balloon skin cover. . Figure 71A is a detailed view of a portion of an engaging edge of the cover member of Figure 70 that includes an elongated protrusion. Figure 71B is a detailed view of another portion of the mating edge of the cover member of Figure 70 that includes an elongated slot. Figure 71C is a detailed view of a portion of a mating interface between two shell members of the balloon skin of Figure 60, when in an assembled configuration where the mating edges of the two shell members engage. each other. Figure 72 is a first side view of the balloon coating of Figure 69 in an assembled configuration and with components arranged within and covered by the balloon coating shown with dashed lines. Figure 73 is a second side view of the balloon skin of Figure 69 in an assembled configuration, where the second side view is rotated from the first side view of Figure 72. Figure 74 is a rear perspective view of the balloon liner of Figure 69, from a proximal end of the balloon liner, in an assembled configuration. Figure 75A is a perspective view of the balloon skin of Figure 69 in an assembled configuration, where the portion of the balloon skin that covers the positioning device has walls that include one or more windows that are configured to reduce a height of the balloon coating. Figure 75B is a rear view of the balloon coating of Figure 75A. Figure 75C is a rear cross-sectional view of the balloon coating of Figure 75A. Figure 76A is a perspective view of another embodiment of a balloon coating for a distal end portion of the delivery apparatus that is configured to cover an inflatable balloon and a positioning device mounted on the distal end portion, where a portion The balloon coating that covers the positioning device has walls that completely enclose the positioning device therein. Figure 7 6B is a rear view of the balloon coating of Figure 7 6A. Figure 77 is an exploded view of another embodiment of a balloon coating for a distal end portion of the delivery apparatus that is configured to cover an unreliable balloon and a positioning device mounted on the distal end portion and create a final shape , specified of the infladle balloon. Figure 78 is a perspective view of a depression sleeve of the balloon liner of Figure 77, the depression sleeve including one or more depression members. Figure 7 9 is a rear view of the depression sleeve of Figure 78. Figure 80 is another perspective view of the depression sleeve of Figure 78. Figure 81A is a cross-sectional side view of the depression sleeve of Figure 78 in an unflexed or resting configuration. Figure 81B is a cross-sectional side view of the depression sleeve of Figure 78 in a flexed or radially inward configuration. Figure 82 is a perspective view of a cover member of the balloon skin of Figure 77 disassembled from the rest of the balloon skin. Figure 83A is a first cross-sectional side view of the assembled balloon skin of Figure 7 7. Figure 83B is a second cross-sectional side view of the assembled balloon skin of Figure 7 7. Figure 84 is a plan view of another illustrative embodiment of a cover member for a balloon liner that is configured to receive a portion of a distal end portion of a delivery apparatus that includes an unreliable balloon and a delivery device. positioning mounted thereon and forming a final, specified shape of the balloon around the delivery apparatus. Figure 85 is a perspective view of the cover member of Figure 84. Figure 86 is a cross-sectional side view of the cover member of Figure 84. Figure 87A is a perspective view of a shaft connector release assembly that couples a proximal end portion of a rotating shaft of a delivery apparatus to an adapter. Figure 87B is a cross-sectional view of the shaft connector release assembly of Figure 87A that couples the proximal end portion of the rotating shaft to the adapter. Figure 88 is an exploded view of the shaft connector release assembly, the proximal end portion of the rotating shaft, and the adapter of Figure 87A. Figure 89 is a perspective view of the shaft connector release assembly of Figure 87A, alone, in an assembled configuration. Figure 90 is an exploded view of the shaft connector release assembly of Figure 89. Figure 91 is a perspective view of one embodiment of a release sleeve of the release sleeve of the shaft connector of Figure 89. Figure 92 is a side view of the release sleeve of Figure 91. Figure 93 is a cross-sectional side view of the release sleeve of Figure 92. Figure 94 is a perspective view of one embodiment of an adapter insert of the shaft connector release assembly of Figure 89. Figure 95 is a side view of the adapter insert of Figure 94. Figure 96 is a cross-sectional side view of the adapter insert of Figure 95. Figure 97 shows an illustrative radiopaque marker sewn to a central portion of a linkage member, the linkage member configured to form a commissure with the commissure tabs of adjacent leaflets of the prosthetic heart valve and configured to be disposed through a cell of a prosthetic heart valve and secure to the struts that form the cell. Figure 98A shows the marker secured to an outer surface of the attachment member of Figure 97 and the commissure tabs secured to an inner surface of the attachment member. Figure 98B shows the attachment member of Figure 98A attached to the cell struts and the marker facing away from the commissure. Figure 99A shows the marker secured to an internal surface of the attachment member of Figure 97 and the commissure tabs secured to an internal surface of the attachment member. Figure 99B shows the attachment member of Figure 99B attached to the cell struts and the marker facing the commissure. Figure 100 shows an illustrative embodiment of a marker positioned against an elongated flap of a link member, the link member configured to form a commissure with the commissure tabs of adjacent leaflets of the prosthetic heart valve and configured to be arranged across of a cell of a prosthetic heart valve and secured to the struts that form the cell. Figures 101A-101E show a process for sewing the marker to the attachment member of Figure 100 through the use of one or more fasteners used to secure the commissure tabs of the leaflets to the attachment member. Figure 102 is a perspective view of another embodiment of a rotating knob mounted on a proximal end portion of an intermediate shaft of a delivery apparatus, the knob configured to rotate the intermediate shaft, thereby rotating an unreliable balloon. and a prosthetic heart valve radially compressed on the balloon. Figure 103 is a side view of the knob of Figure 102. Figure 104 is a first exploded view of the knob of Figure 102 showing two housing portions of the knob enclosing an anchor and an adapter therein. Figure 105 is a second exploded view of the knob of Figure 102. Figure 106 is a first cross-sectional side view of the knob of Figure 102 showing the anchor and adapter inside the knob housing. Figure 107 is a second cross-sectional side view of the knob of Figure 102 showing an anchor and adapter alignment tab within the knob housing. Figure 108 is a perspective view of another embodiment of a balloon covering for a distal end portion of the delivery apparatus that is configured to cover an inflatable balloon and a positioning device mounted on the distal end portion. Figure 109 is a side view of the balloon coating of Figure 108. Figure 110 is an exploded view of the balloon coating of Figure 108. Figure 111 is another side view of the balloon liner of Figure 108 showing a sleeve covering a portion of the balloon liner that includes a viewing window for a radiopaque marker underlying the distal end portion of the delivery apparatus. Figure 112 is another side view of the balloon liner of Figure 111 with the sleeve removed so that the viewing window and underlying radiopaque marker on the distal end portion of the delivery apparatus are visible. Figure 113 is a perspective cross-sectional view of the balloon coating of Figure 108. Figure 114 is a partial cross-sectional side view of the balloon coating of Figure 108. Detailed description of the invention General considerations For the purposes of this description, certain aspects, advantages, and novel features of the embodiments of this description are described in the present description. The methods, systems, and apparatus described should not be construed as limiting in any way. Instead, the present description is directed toward all novel and non-obvious features and aspects of the various modalities described, alone and in various combinations and subcombinations with each other. The methods, systems, and apparatus described are not limited to any specific aspect, feature, or combination thereof, nor do the methods, systems, and apparatus described require that any one or more specific advantages be present, or problems be resolved. The characteristics, integers, characteristics, compounds, chemical moieties, or groups described in conjunction with a particular aspect, embodiment, or example of the description are to be understood as applicable to any other aspect, embodiment, or example described herein unless incompatible. with them. All features described in this description (including any claims, summary, and accompanying figures), and / or all steps of any method or process so described, may be combined in any combination, except combinations where at least some of such features and / or stages are mutually exclusive. The description is not restricted to the details of any of the above modalities. The description extends to any novel feature, or any novel combination, described in this description (including any of the claims, abstracts, and accompanying figures), or to any novel step, or any novel combination, of any method or process so described. . Although the operations of some of the methods described are described in a particular, sequential order for convenient presentation, it should be understood that this form of description encompasses reordering, unless a particular order is required by specific language set forth below. For example, operations described sequentially may in some cases be rearranged or performed simultaneously. Furthermore, for the sake of simplicity, the accompanying figures may not show the various ways in which the methods, systems, and apparatus described may be used in conjunction with other systems, methods, and apparatus. As used herein, the terms a one and at least one encompass one or more of the specified element. That is, if two of a particular element are present, one of these elements is present in addition and therefore one element is present. The terms a plurality of and plural mean two or more of the specified element. As used herein, the term and / or used between the last two of a list of elements means any one or more of the listed elements. For example, the phrase A, B, and / or C means A, B, C, A and B, A and C, B and C, or A, B, and C. As used herein, the term coupled generally means coupled or physically joined and does not exclude the presence of intermediate elements between the coupled elements without specific contrary language. Directions and other relative references (e.g., internal, external, upper, lower, etc.) may be used to facilitate discussion of the figures and principles in the present description, but are not intended to be limiting. For example, certain terms may be used such as inside, outside, top, bottom, inside, outside, and the like. Such terms are used, where applicable, to provide some clarity of description when dealing with relative relationships, particularly with respect to the illustrated embodiments. However, such terms are not intended to imply absolute relationships, positions, and / or orientations. For example, with respect to an object, a top part can become a bottom part simply by rotating the object. However, it is still the same part and the object is still the same. As used herein, and / o means and or o, as well as and and or. As used herein, with reference to the prosthetic heart valve and the delivery apparatus, proximal refers to a position, direction, or portion of a component that is closest to the user and / or a handle of the delivery apparatus. that is away from the patient, while distal refers to a position, direction, or portion of a component that is away from the user and / or the handle of the delivery apparatus and closer to the implantation site. The terms longitudinal and axial refer to an axis extending in the proximal and distal directions, unless expressly defined otherwise. Additionally, the term radial refers to a direction that is arranged perpendicular to the axis and points along a radius from a center of an object (where the axis is placed at the center, such as the longitudinal axis of the prosthetic valve). . Examples of technology described Described herein are examples of prosthetic valve delivery apparatus and methods for delivering and implanting a radially expandable prosthetic valve into a native valve of a heart such that the commissures of the prosthetic valve align circumferentially within the commissures of the native valve. Further described herein are examples of balloon liners configured to receive a portion of the distal end of a delivery apparatus therein. In some embodiments, such balloon coverings may be configured to create a specified shape of an inflatable balloon that covers a portion of the distal end of the delivery apparatus. Further described herein are assemblies for coupling a rotating shaft of the delivery apparatus to an adapter of the delivery apparatus that is configured to receive inflation fluid for the unreliable balloon of the delivery apparatus. In some embodiments, a delivery apparatus may include a first axis that is configured to rotate about a central longitudinal axis of the delivery apparatus to rotatably align a prosthetic valve mounted on the delivery apparatus with the native anatomy at a site of target implementation. The delivery apparatus may further include a second shaft extending through the first shaft and having a distal end portion extending distally beyond a distal end portion of the first shaft. In some embodiments one or more polymeric bodies, such as one or more balloon flanges and / or a nose cone may be mounted on the distal end portion of the second shaft. The delivery apparatus may further include an inflatable balloon coupled to the distal end portion of the first shaft. In some embodiments, a flange, or other polymeric body of the delivery apparatus, may be disposed within the balloon and a radiopaque marker may be mounted on or incorporated within the flange at a location spaced radially outward from an outer surface of the distal end portion. of the second axis. The marker may be reflective asymmetrical along an axis that is parallel to the central longitudinal axis of the delivery apparatus. The flange may be configured such that when the prosthetic valve is mounted on the balloon in a radially compressed state, the flange resists movement of the prosthetic valve relative to the balloon in an axial direction. In this way, the delivery apparatus can be configured to rotatably align the radially compressed prosthetic valve in the native valve such that the prosthetic valve is implanted with the commissures of the prosthetic valve in alignment (e.g., circumferential alignment) with the commissures of the native valve. For example, rotating the first axis may result in rotation of the balloon and the radially compressed prosthetic valve mounted thereon. In some embodiments, the first axis may be rotated at or near the native valve until the marker on the alternative polymeric flange or body of the delivery apparatus aligns with a desired reference mark of the native anatomy and / or a guide, within of a selected image view. The prosthetic valves described herein may be radially compressible and expandable between a radially compressed configuration and a radially expanded configuration. Therefore, prosthetic valves can be curled in a delivery apparatus into the radially compressed configuration during delivery, and then expanded to the radially expanded configuration once the prosthetic valve reaches the implantation site. In some embodiments, the prosthetic valve may be deployed from the delivery apparatus at the implantation site (e.g., a native valve of a heart) through inflation of an unreliable balloon of the delivery apparatus. Figure 1 shows a prosthetic heart valve (e.g., prosthetic valve) 10, according to one embodiment. The illustrated prosthetic valve is adapted for implantation in the native aortic annulus, although in other embodiments it may be adapted for implantation in the other native annular spaces of the heart (e.g., the pulmonary, mitral, and tricuspid valves). The prosthetic valve may further be adapted to be implanted in other tubular organs or passages in the body. The prosthetic valve 10 may have four main components: a stent or frame 12, a valve structure 14, an inner skirt 16, and a perivalvular outer sealing member or outer skirt 18. The prosthetic valve 10 may have an inlet end portion 15, an intermediate portion 17, and an outlet end portion 19. The valve structure 14 may comprise three leaflets 40, which collectively form a leaflet structure, which may be arranged to collapse into a tricuspid arrangement, although in other embodiments there may be a greater or lesser number of leaflets (e.g., one or more leaflets 40). ). The leaflets 40 may be secured together on their adjacent sides to form the commissures 22 of the valve structure (e.g., leaflet) 14. The lower edge of the valve structure 14 may have an undulating, scalloped curve shape and may be secured to the inner skirt. 16 by sutures (not shown). In some embodiments, leaflets 40 may be formed from pericardial tissue (e.g., bovine pericardial tissue), biocompatible synthetic materials, or various other suitable natural or synthetic materials as are known in the art and described in United States Patent No. 6,730,118, which is incorporated by reference herein. The frame 12 may be formed with a plurality of circumferentially spaced apart slots, or commissure windows 20 that are adapted to mount the commissures 22 of the valve structure 14 to the frame. The frame 12 may be made of any of a number of suitable plastically expandable materials (e.g., stainless steel, etc.) or self-expanding materials (e.g., nickel-titanium alloy (NiTi), such as nitinol), as is known in the art. technique. When constructed of a plastically expanded material, the frame 12 (and therefore the prosthetic valve 10) can be curled into a radially collapsed configuration into a delivery catheter and then expanded within a patient by an unreliable balloon or expansion mechanism. equivalent. When constructed of a self-expanding material, the frame 12 (and therefore the prosthetic valve 10) can be curled into a radially collapsed configuration and restricted in the collapsed configuration by insertion into a sheath or equivalent mechanism of a delivery catheter. Once inside the body, the prosthetic valve can be advanced from the delivery envelope, allowing the prosthetic valve to expand to its functional size. Suitable plastically expandable materials that can be used to form the frame 12 include, without limitation, stainless steel, biocompatible, high strength alloys (for example, a cobalt-chromium or nickel-cobalt-chromium alloys), polymers, or their combinations. In particular embodiments, the frame 12 is made of a nickel-cobalt-chromium-molybdenum alloy, such as alloy MP35N® (SPS Technologies, Jenkintown, Pennsylvania), which is equivalent to alloy UNS R30035 (coated by ASTM F562- 02). Alloy MP35N® / Alloy UNS R30035 comprises 35% nickel, 35% cobalt, 20% chromium, and 10% molybdenum, by weight. Additional details regarding the prosthetic valve 10 and its various components are described in WIPO Patent Application Publication No. WO 2018 / 222799, which is incorporated herein by reference. Figure 2A is a perspective view of a prosthetic heart valve 50, according to another embodiment. The prosthetic valve 50 may have three main components: a stent or frame, 52, a valve structure 54, and a sealing member 56. Figure 2B is a perspective view of the prosthetic valve 50 with the components on the outside of the frame. 52 (including sealing member 56) shown in transparent lines for illustration purposes. Similar to the valve structure 14 of Figure 1, the valve structure 54 may comprise three leaflets 60, which collectively form a leaflet structure, which may be arranged to collapse into a tricuspid arrangement. Each leaflet 60 can be attached to the frame 52 along its leading edge 62 (the lower edge in the figures; further referred to as cusp edges) and at the commissures 64 of the valve structure 54 where adjacent portions (e.g., tabs of commissures) of two valves are connected to each other. In some embodiments, the commissures 64 may comprise a joining member (e.g., comprising fabric, flexible polymer, or the like) disposed across a cell (e.g., commissure cell) of the frame 52, the cell formed by struts. of the frame. The connecting member may be secured to the struts of the frame forming the cell and adjacent portions of the two leaflets may be connected to the connecting member to form the commissure 64 (for example, as shown in Figures 16 and 17, as shown). described further below). A reinforcing member (not shown), such as a strip of fabric, may be connected directly to the cusp edges of the leaflets and to the frame struts to engage the cusp edges of the leaflets to the frame. Similar to frame 12 of Figure 1, frame 52 can be made of any of a number of suitable plastically expandable materials or self-expanding materials, as is known in the art and described above. The frame 52 in the illustrated embodiment comprises a plurality of circumferentially extending rows of angled struts 72 that define rows of cells, or openings, 74 of the frame. The frame 52 may have a cylindrical or substantially cylindrical shape having a constant diameter from an inlet end 66 to an outlet end 68 of the frame as shown, or the frame may vary in diameter along the height of the frame, as described in United States Patent Publication No. 2012 / 0239142, which is incorporated herein by reference. The frame 52, at each of the inlet end 66 and the outlet end 68, may comprise a plurality of apices 80 spaced apart about a circumference of the frame 52. The sealing member 56 in the illustrated embodiment is mounted on the exterior of the frame 52 and functions to create a seal against the surrounding tissue (e.g., the leaflets and / or the native annulus) to prevent or at least minimize leakage to valvular. The sealing member 56 may comprise an inner layer 7 6 (which may be in contact with the outer surface of the frame 52) and an outer layer 78. The sealing member 56 may be connected to the frame 52 by using suitable techniques or mechanisms. . For example, the sealing member 56 may be sutured to the frame 52 via sutures that may extend around the struts 72 and through the inner layer 76. In alternative embodiments, the inner layer 76 may be mounted on the inner surface of the frame 52. , while the outer layer 78 is on the outside of the frame 52. The outer layer 78 may be configured or formed to extend radially outward from the inner layer 76 and the frame 52 when the prosthetic valve 50 is deployed. When the prosthetic valve is expanded completely outside of a patient's body, the outer layer 78 may expand in the opposite direction of the inner layer 76 to create a space between the two layers. Therefore, when implanted within the body, this allows the outer layer 78 to expand in contact with the surrounding tissue. Additional details regarding prosthetic valve 50 and its various components are described in United States Patent Publication No. 2018 / 0028310, which is incorporated herein by reference. Figure 3 shows a delivery device (e.g., apparatus) 100, according to one embodiment, that can be used to implant an expandable prosthetic heart valve (e.g., prosthetic valve 10 or 50), or another type of prosthetic medical device. expandable (such as a stent). In some embodiments, the delivery device 100 is specifically adapted for use in introducing a prosthetic valve into a heart. The delivery device 100 in the illustrated embodiment of Figure 3 is a balloon catheter comprising a handle 102, a steerable, an outer shaft 104 extending from the handle 102, an intermediate shaft extending from the handle 102 coaxially through the steerable outer shaft 104, and an inner shaft 106 extending from the handle 102 coaxially through the intermediate shaft and the steerable, outer shaft 104, a non-reliable balloon (e.g. balloon) 108 extending from a distal end of the intermediate shaft, and a nose cone 110 disposed at a distal end of the delivery device 100. A portion of the distal end 112 of the delivery device 100 includes the balloon 108, the nose cone 110, and an assembly edge of the globe. A prosthetic medical device, such as a prosthetic heart valve may be mounted on a valve retention portion of the balloon 108, as further described below with reference to Figures 9-11, 41, and 42. As further described below Below, the balloon rim assembly is configured to maintain the prosthetic heart valve or other medical device in a fixed position on the balloon 108 during delivery through the patient's vasculature. In some embodiments, the balloon rim assembly may include a proximal rim 120 and / or a distal rim 122. The handle 102 may include a steering mechanism configured to adjust the curvature of the distal end portion of the delivery device. In the illustrated embodiment, for example, the handle 102 includes an adjustment member, such as the illustrated rotary knob 134, which in turn is operatively coupled to the proximal end portion of a traction cable (not shown). The traction cable extends distally from the handle 102 through the outer shaft 104 and has a distal end portion secured to the outer shaft at or near the distal end of the outer shaft 104. Turning the knob 134 is effective to increase or decrease the tension on the traction cable, thereby adjusting the curvature of the distal end portion of the delivery device. In some embodiments, the delivery apparatus (or other, similar delivery apparatus) may be configured to deploy and implant a prosthetic heart valve (e.g., prosthetic valve 10 of Figure 1 or prosthetic heart valve 50 of Figures 2A and 2B). in the native aortic annular space of a native aortic valve. An illustrative heart 200 including an aortic valve 202 is shown in Figure 4. As shown in Figure 4, two coronary arteries (e.g., the left coronary artery and the right coronary artery) 204 attach to and branch from the aorta. 205, near the aortic valve 202. The coronary arteries 204 carry oxygenated blood from the aorta to the heart muscle 200. As shown in Figure 5A, since the prosthetic heart valve 206 is implanted in the native aortic annular space of the aortic valve 202, blood flow 208 can exit the prosthetic heart valve 206, flow into the aorta 205, and then flow over the top of the outlet end of the prosthetic heart valve 206 and / or through open cells (e.g., open cells that are not constantly covered by the leaflets of the prosthetic heart valve) in the frame of the prosthetic heart valve 206, to coronary artery 204 (only one shown in Figures 5A and 5B). Depending on a patient's anatomy, the prosthetic heart valve may overlie (e.g., be placed in front of) at least a portion of the opening to the coronary artery 204, as shown in the example depicted in Figure 5B. Interference with blood flow to the coronary arteries 204 may further be exacerbated when a commissure 210 of the prosthetic heart valve 206 is disposed in front of (e.g., adjacent to) an opening to one of the coronary arteries 204 (Figure 5B). For example, since adjacent leaflets engage together at commissures 210, commissures 210 block and / or reduce blood flow through the cells to which they engage. Therefore, less oxygenated blood flow can reach the coronary arteries and heart muscle. Therefore, instead of deploying the prosthetic heart valve with the delivery apparatus in a random rotational orientation relative to the aorta 205, which may result in the commissures 210 of the prosthetic heart valve 206 being arranged in front of the coronary arteries 204 (as shown in Figure 6A), it may be desirable to deploy the prosthetic heart valve 206 in a directed rotary orientation where the commissures 210 are positioned away from and do not block the coronary arteries 204 (as shown in the Figure 6B). For example, as shown in Figure 6B, the delivery apparatus can be configured to deploy the prosthetic heart valve 206 such that the commissures 210 of the radially expanded prosthetic heart valve 206 align circumferentially with the native commissures 212 of the aortic valve. 202. As further explained below, the delivery apparatus may be configured to control rotary positioning of the prosthetic heart valve. 206 in relation to the native valve, to achieve the alignment of the commissure shown in the example of Figure 6B, thereby increasing blood flow access to the coronary arteries 204. Additionally, this positioning of the prosthetic heart valve can facilitate a subsequent, leaflet-cutting procedure that provides greater blood flow to the coronary arteries, as shown in Figures 7-8B. For example, as shown in Figure 7, a native leaflet 214 of the native valve (e.g., aortic valve 202) may be divided (e.g., cut) longitudinally (relative to a central longitudinal axis of the prosthetic heart valve 206). ) at a location of an entrance to a coronary artery 204. This allows greater blood flow to enter the coronary artery 204 from the aorta, through one or more open cells (e.g., not covered by the leaflets) 216 of the prosthetic heart valve 206. As shown in Figure 8A, dividing a native leaflet 214 (shown surrounding the prosthetic heart valve 206 in Figures 8A and 8B) into a region of a frame of the prosthetic heart valve 206 that is between two adjacent commissures 210 results in resulting in open cells 216 that can receive blood flow through them. However, as shown in Figure 8B, dividing the native leaflet 214 into a region of the prosthetic heart valve frame 206 that includes the commissure 210 (for example, because the commissure 210 is positioned in front of the entrance to the coronary artery 204), does not result in the open cells 216 being arranged in front of the entrance to the coronary artery 204. Instead, the commissure 210 can continue to block blood flow to the coronary artery 204. Therefore, it is desirable to have apparatus and delivery methods for deploying radially expandable prosthetic heart valves in a desired rotary orientation relative to the native valve, such that the commissures of the prosthetic heart valve are in alignment with the commissures of the valve. native. Figures 9-68 show embodiments of delivery apparatus, methods and related components, for implanting a radially expandable prosthetic heart valve into a native valve with a delivery apparatus such that the commissures of the prosthetic heart valve align with the commissures of the native valve. In some embodiments, the prosthetic valve and delivery apparatus are configured such that the prosthetic valve is deployed from the delivery apparatus to the native valve through inflation of a balloon of the delivery apparatus. Figures 9-14 show a delivery apparatus 300, according to one embodiment, that can be used to implant an expandable prosthetic heart valve (e.g., prosthetic valve 10 of Figure 1 or prosthetic valve 50 of Figures 2A-2B ), or another type of expandable prosthetic medical device (such as a stent). In some embodiments, the delivery apparatus 300 is specifically adapted for use in introducing a prosthetic valve into a heart. As further described below, the delivery apparatus 300 may be configured to rotate the prosthetic valve, mounted on the delivery apparatus in a radially compressed state, at the target implantation site (e.g., on a native heart valve) to achieve commissure alignment between the native valve and the prosthetic valve after deploying the prosthetic valve. Similar to the delivery device 100 of Figure 3, the delivery apparatus 300 is a balloon catheter comprising a handle 302 and an outer, steerable shaft 304 extending distally from the handle 302 (Figures 9 and 14). The delivery apparatus 300 may further comprise an intermediate shaft 306 (which may further be referred to as a balloon shaft) extending proximally from the handle 302 (Figures 9 and 14) and distally from the handle 302, the portion extending distally from the handle 302 further extending coaxially through the outer shaft 304. Additionally, the delivery apparatus 300 may further comprise an inner shaft 308 extending distally from the handle 302 coaxially through the intermediate shaft 306 and the outer shaft 304 ( as shown in the detailed portion 355 in Figure 13) and proximally from the handle 302 coaxially through the intermediate shaft 306. As further described below, the outer shaft 304 and the intermediate shaft 306 are configured to translate (e.g., move) longitudinally, along the central longitudinal axis 320, relative to each other to facilitate the delivery and placement of a prosthetic valve. at an implantation site in a patient's body. The intermediate shaft 306 may include a proximal end portion 310 that extends proximally from a proximal end of the handle 302, to an adapter 312 (Figures 9 and 14). A rotating knob 314 may be mounted on the proximal end portion 310 (Figures 9 and 14) and may be configured to rotate the intermediate shaft 306 about a central longitudinal axis 320 of the delivery apparatus 300 and relative to the outer shaft 304, as shown. further described below with reference to Figures 15-22. The adapter 312 may include a first port 338 configured to receive a guide therethrough and a second port 340 configured to receive fluid (e.g., inflation fluid) from a fluid source. The second port 340 may be fluidly coupled to an internal lumen of the intermediate shaft 306, as further described below. The intermediate shaft 306 may further include a portion of the distal end 316 that extends distally beyond a distal end of the outer shaft 304 (Figures 10 and 11) when a distal end of the outer shaft 304 is positioned against a non-reliable balloon. 318 of the delivery apparatus (for example, as further described below with reference to Figures 38-41). A distal end portion of the inner shaft 308 may extend distally beyond the distal end portion 316 of the intermediate shaft 306 (Figure 10). The balloon 318 engages the distal end portion 316 of the intermediate shaft 306. For example, in some embodiments, a proximal end portion of the balloon 318 engages to and / or around a distal end 348 of the intermediate shaft 306 (Figures 10 and 11). The balloon 318 may comprise a distal end portion (or section) 332, a proximal end portion (or section) 333, and an intermediate portion (or section) 335, the intermediate portion 335 disposed between the distal end portion 332 and the proximal end portion 333. In some embodiments, a distal end of the distal end portion 332 of the balloon 318 may be coupled to a distal end of the delivery apparatus 300, such as to a nose cone 322 (as shown in Figures 9-11), or to an alternative component at the distal end of the delivery apparatus 300 (e.g., a distal flange). In some embodiments, the intermediate portion 335 of the balloon 318 may cover a valve mounting portion 324 of a distal end portion 309 of the delivery apparatus 300, the distal end portion 332 may cover a distal flange 326 of the delivery apparatus 300, and the proximal end portion 333 may surround a portion of the internal shaft 308 (Figure 10). The valve mounting portion 324 and the intermediate portion 335 of the balloon 318 may be configured to receive a prosthetic heart valve in a radially compressed state (e.g., as shown in Figures 41 and 42, as further described below). . As further described below, rotation of the intermediate shaft 306 results in rotation of the balloon 318 and the prosthetic valve mounted thereon for rotary positioning of the prosthetic valve relative to the native anatomy at the target implantation site. . The balloon rim assembly is configured to maintain the prosthetic heart valve or other medical device in a fixed position on the balloon 318 during delivery through the patient's vasculature. The balloon flange assembly may include a distal flange 326 (Figures 9-11) disposed within a distal end portion of the balloon 318 and coupled to the distal end portion of the inner shaft 308. The distal flange 326 may be configured to resist the movement of the prosthetic valve or other medical device mounted distally on the valve mounting portion 324, in an axial direction (e.g., along the central longitudinal axis 320), relative to the balloon 318. For example, in some embodiments, the distal flange 326 may include a flared portion 331 disposed adjacent the valve mounting portion 324 (Figure 10). In some embodiments, the flared portion 331 may include a plurality of flares 330 that flare radially outward from a base portion 325 (e.g., shaft) of the distal flange 326 (Figure 10), toward the valve mounting portion. 324 (as discussed in more detail below with reference to Figures 28, 32A-32B, and 40-42). The outer shaft 304 may include a distal tip portion 328 mounted at its distal end (Figures 9 and 11). In some embodiments, the distal tip portion 328 may be configured as a flexible adapter that includes a plurality of internal and external helical grooves, as further described below with reference to Figures 38-41. The outer shaft 304 and the intermediate shaft 306 can be axially translated relative to each other to position the distal tip portion 328 adjacent to a proximal end of the valve mounting portion 324, when a prosthetic valve is mounted in the radially compressed state in the valve mounting portion 324 and during delivery of the prosthetic valve to the target implantation site (e.g., as shown in Figure 41). As such, the distal tip portion 328 may be configured to resist movement of the prosthetic valve relative to the balloon 318 proximally, in the axial direction, relative to the balloon 318, when the distal tip portion 328 is disposed adjacent to one side. proximal of the valve mounting portion 324. In some embodiments, the nose cone 322 may be disposed distal to and engage the distal flange 326. In some embodiments, the nose cone 322 may engage the distal end portion of the inner shaft 308. In some embodiments, the delivery apparatus 300 may comprise one or more markers or bands of markers 353 that are configured to indicate to a user a location of a specified component of the delivery apparatus. In some embodiments, the one or more marker bands 353 may be radiopaque. In some embodiments, one or more marker bands 353 may be radially compressed (e.g., curled) about the internal axis 308 (Figures 10 and 11 and further shown in Figures 32A and 40). As shown in Figure 10, the distal end portion 332 of the balloon 318 may include a radial depression 334 that depresses inwardly, toward the central longitudinal axis 320, relative to an outermost radial surface of the distal rim 326 and a Outermost radial surface of the nose cone 322. The radial depression 334 is described in more detail below with reference to Figures 40 and 41. As shown in the detail, cross-sectional view of a selected portion 355 (of Figure 11) of the delivery apparatus 300 of Figure 13, an annular space 336 may be defined between an outer surface of the inner shaft 308 and a surface internal lumen of the intermediate shaft 306. In some embodiments, the annular space 336 may be referred to as an internal lumen of the intermediate shaft 306. In some embodiments, the annular space 336 may be configured to receive fluid from a fluid source through the second port 340 of the adapter 312 (e.g., annulus 336 is in fluid communication with second port 340 of adapter 312). The annular space 336 may be fluidly coupled to a fluid passage 342 formed between the outer surface of the distal end portion of the inner shaft 308 and an inner surface of the balloon 318 (Figure 10). As such, fluid from the fluid source can flow into fluid passage 342 from annulus 336 to inflate balloon 318 and radially expand and deploy the prosthetic valve. An internal lumen 344 of the internal shaft 308 (Figure 13) may be configured to receive a guide therethrough, to navigate the distal end portion 309 of the delivery apparatus 300 to the target implantation site. As introduced above, the first port 338 of the adapter 312 can be coupled to the internal lumen 344 and configured to receive the guide. For example, the distal end portion 309 of the delivery apparatus 300 may be advanced over the guide to the target implantation site. Illustrative guides are shown in Figures 29, 31A-31B, 34A-34B, and 59, as further described below. As shown in the schematic of the intermediate shaft 306 in Figure 12 and in the detail, cross-sectional view of the selected portion 355 (Figure 11) of the supply apparatus 300 in Figure 13, in some embodiments, the intermediate shaft 306 (e.g., balloon) may include two layers of a braided (or coiled) material that are configured to increase the torque resistance of the intermediate shaft 306 so that it can resist rotation at the target implantation site. The braided or wound material may comprise a more rigid braided or wound material, such as metal or polyethylene terephthalate (PET). For example, the intermediate shaft 306 may be broken into a first portion 346 having a first length 356 and a second portion 354 having a second length 358, the first length 356 longer than the second length 358 (Figure 12). The first length 356 may be a majority of a total length of the intermediate shaft 306. In some embodiments, the second length 358 may be in a range of 4 to 10 inches, 4 to 8 inches, or 5 to 7 inches. In some embodiments, the second length358 may be approximately 6 inches. Therefore, the first portion 346 may extend from the proximal end portion 310 of the intermediate shaft 306 for a distance (e.g., second length 358) in the opposite direction of the distal end 348 of the intermediate shaft 306. The two layers of braided material of the intermediate shaft 306 may include a first braided layer 350 that extends along the entire length of the intermediate shaft 306 (to the distal end 348), along both the first portion 346 and the second portion 354 (Figure 13). The two layers of intermediate shaft braided material 306 may further include a second braided layer 352 that extends most of the entire length of the intermediate shaft. 306, along the first portion 346 (Figure 13). However, the second braided layer 352 stops before the second portion 354 (Figures 12 and 13). This may allow the second, distal portion 354 of the intermediate shaft 306 to have greater flexibility at the distal end portion 316. In alternative embodiments, the second braided layer 352 may extend the entire length of the intermediate shaft 306. In some alternative embodiments, the intermediate shaft 306 may include more than two layers of braided material, such as three. As shown in Figures 9 and 14, the handle 302 may include a steering mechanism configured to adjust the curvature of the distal end portion 309 of the delivery apparatus 300. In the illustrated embodiment, for example, the handle 102 includes a adjustment member, such as the illustrated rotary knob 360, which in turn is operatively coupled to the proximal end portion of a traction cable. The traction cable may extend distally from the handle 302 through the outer shaft 304 and has a distal end portion secured to the outer shaft 304 at or near the distal end of the outer shaft 304. Turning the knob 360 may increase or decrease the tension. in the traction cable, thereby adjusting the curvature of the distal end portion 309 of the delivery apparatus 300. Additional details on the steering or bending mechanisms for the delivery apparatus can be found in United States Patent No. . 9,339,384, which is incorporated by reference herein. The handle 302 may further include an adjustment mechanism 361 that includes an adjustment member, such as the illustrated rotary knob 362, and a shaft 364 extending distally toward a housing 366 of the handle 302. The adjustment mechanism 361 is configured to adjust the axial position of the intermediate shaft 306 in relation to the outer shaft 304 (Figures 9 and 14). In some embodiments, as shown in Figure 14, an internal support 368 is mounted within the housing 366 on the intermediate shaft 306 and an internal shaft 370 (further referred to as a slider or sliding mechanism) is mounted on the internal support 368. The inner shaft 370 has a distal end portion 372 formed with external threads that engage with internal threads extending along the inner surface of the shaft 364. The inner shaft 370 further includes a proximal end portion 374 that extends along the inner surface of the shaft 364. mounts and interacts with a locking mechanism 376, which is configured to retain (e.g., lock) the position of the intermediate shaft 306 relative to the handle 302. The internal shaft 370 may be coupled to the internal support 368 such that rotation of the shaft 364 causes the internal shaft 370 to move axially within the handle 302. The locking mechanism 376 may include another adjustment member, configured as a rotating knob 378 that houses an internal nut 380 with internal threads that engage the external threads of the proximal end portion 374 of the inner shaft 370. To restrict the movement of the intermediate shaft 306 for fine positioning of the prosthetic valve mounted on the distal end portion of the delivery apparatus 300, knob 378 is rotated, which in turn causes rotation of the internal nut 380. As a result , the inner nut 380 translates in the distal direction along the external threads on the proximal end portion 374 of the inner shaft 370. As the nut 380 moves distally, additional components of the locking mechanism 376 are configured to frictionally engage the intermediate shaft 306, thereby retaining the intermediate shaft 306 relative to the internal shaft 370. In the locked position, rotation of the knob 362 causes the internal shaft 370 and the intermediate shaft 306 to move axially relative to the outer axis 304 (either in the proximal or distal direction, depending on the direction in which the knob 362 is rotated). Turning knob 378 in the opposite direction from the locked position to the unlocked position allows axial and rotary movement of the intermediate shaft relative to the internal shaft 370 and the proximal end portion of the handle 302. Additional details can be found in the mechanism adjusting mechanism 361 and locking mechanism 376 of handle 302 in United States Patent No. 9,339,384, which is incorporated by reference herein. As introduced above, the knob 314 of the handle 302 can be configured to rotate the intermediate shaft (e.g., balloon) 306, thereby rotating the balloon 318 mounted on the intermediate shaft 306 and a radially compressed prosthetic valve mounted on the globe 318, around the valve mounting portion 324. Therefore, turning the knob 314 can rotate the prosthetic valve, around the central longitudinal axis 320, into a desired orientation relative to the native anatomy at the implantation site. aim. Figures 15-22 show various views of one embodiment of the knob 314, which is configured to rotate the intermediate shaft 306 with rotation of the knob 314. In alternative embodiments, a differently configured rotating knob or other rotation mechanism may be used. fit in place of the knob 314, to rotate the intermediate shaft 306 of the supply apparatus 300. As shown in the perspective views of Figures 15 and 16 (and Figures 9 and 14, as described above), the knob 314 may be mounted on the proximal end portion 310 of the intermediate shaft 306, distal to the adapter 312. In some embodiments, knob 314 may be attached directly to and / or disposed around a portion or all of adapter 312 (e.g., as shown in Figures 102-107, which are further described below). In alternative embodiments, knob 314 may be axially separated away from adapter 312. Knob 314 may include an outer casing 382 disposed around (e.g., casing) one or more internal components of knob 314 (Figures 15-17 and 20). In some embodiments, the outer casing 382 may include one or more fastening elements 383 configured to increase traction or grip for a user to turn the knob 314. In some embodiments, the one or more fastening elements 383 may be elements or raised features that extend outwardly from an outer surface of the outer casing 382 and space from each other about a circumference of the outer casing 382. In alternative embodiments, the one or more fastening elements 383 may be raised ridges and / or depressed grooves in outer casing 382. In some embodiments, to increase the ease of assembly of the knob 314, the outer casing 382 may be divided into two or more mating components. For example, in some embodiments, as shown in the Figures 15, 16 and 20, the outer casing 382 may comprise a first casing portion 384 and a second casing portion 385 that are configured to removably engage each other. For example, each of the first housing portion 384 and the second housing portion 385 may include a corresponding mating interface configured to couple the first housing portion 384 and the second housing portion 385 to each other. In this way, the first housing portion 384 and the second housing portion 385 can be coupled together, around the intermediate shaft 306 and the internal components of the knob 314, thereby forming the knob (e.g. knob assembly) 314. The knob 314 may further comprise an anchor 386 disposed within the outer casing 382 and configured to anchor (e.g., engage) the knob 314 to the proximal end portion 310 of the intermediate shaft 306 (Figures 17-19). Figure 19 shows a cross-sectional view of the knob 314 with the anchor 386 engaged to the intermediate shaft 306 and the outer casing 382 engaged around the anchor 386. Figures 18 and 19 show a cross-sectional view and a perspective view, respectively, of anchor 386. As shown in Figures 17-19, the anchor 386 may comprise a portion of the shaft 387 that defines an internal lumen 388 configured to receive and engage about the intermediate shaft 306. In some embodiments, the internal lumen 388 has a relatively internal diameter constant. In some embodiments, a distal end of the shaft portion 387 may include one or more radial extensions 389 that extend around at least a portion of a circumference of the shaft portion 387 (Figures 17-19). In some embodiments, one or more or each of the radial extensions 389 may extend around the entire circumference of the shaft portion 387. In some embodiments, the one or more radial extensions 389 may be configured as annular prongs that are axially spaced apart. Yeah. The one or more radial extensions 389 may be configured to engage with an interior of a sleeve member (which may further be referred to as a strain relief member) 391 (Figure 17). In some embodiments, the sleeve element 391 may be disposed around a portion of the proximal end 310 of the intermediate shaft 306 and the outer casing 382 may include a first, wider opening 392 configured to receive therein and / or clamp around a proximal end of sleeve element 391 (Figures 15-17). The sleeve member 391 may be configured to relieve deformation between the knob and the proximal end portion of the second shaft. In some embodiments, the sleeve member 391 may comprise a flexible and / or elastic material such as an elastic polymeric material (e.g., rubber). The outer casing 382 may further include a second, narrower opening (e.g., channel) 393 configured to receive a distal portion of the adapter 312 (Figures 17 and 20). As shown in Figures 17-19, the anchor 386 may comprise one or more or a plurality of extension portions (e.g., shafts or pins) 394 that are configured to engage with (e.g., extend inward and / or engage with) the corresponding channels or openings 395 provided in the outer casing 382 (Figures 17 and 20). The extension portions 394 may be separated from each other and extend radially outward from the shaft portion 387 of the anchor 386. In some embodiments, as shown in Figures 17-19, the anchor 386 may comprise two extension portions 394 extending from each of two opposite sides of the anchor 386. However, in alternative embodiments, the anchor 386 may comprise more or less than four extension portions 394. A number of the openings 395 may be the same as the number of extension portions 394. In some embodiments, the openings 395 and an engaging portion of the corresponding extension portions 394 may have a hexagonal shape. However, in alternative embodiments, other shapes are possible, such as rectangular, square, or the like. In some embodiments, the anchor 386 may be configured to join (e.g., ÜV joint) to an outer surface of the intermediate shaft 306. For example, in some embodiments, the shaft portion 387 of the anchor 386 may include one or more centering ribs. 396 separated around a circumference of the internal lumen 388 and extending along the internal lumen 388 (Figures 18 and 19). In some embodiments, the shaft portion 387 may include a viewing opening 397 (e.g., configured as a window) that may allow a user to view an alignment and / or joint between the anchor 386 and the intermediate shaft 306 (Figures 18 and 19). For example, as shown in Figure 17, the opening 397 may extend between an outer surface and an inner surface of the shaft portion 387 and be disposed in a central portion of the shaft portion 387. In some embodiments, a portion of the Proximal end of the shaft portion 387 of the anchor 386 may include a countersink 398 (Figures 17 and 18). The countersink 398 may allow for an improved UV bond between the anchor 386 and the intermediate shaft 306. The knob 314 may further include an alignment or extension tab 399 (Figures 21-22) configured to align the adapter 312 with a radiopaque marker disposed on the distal end portion 309 of the delivery apparatus 300 (e.g., marker 500 shown in Figure 28, marker 600 shown in Figures 32A-32B, or marker 650 shown in Figure 33). In some embodiments, as shown in Figures 21 and 22, the alignment tab 399 may extend radially outward from the anchor 386. In some embodiments, the alignment tab 399 may extend radially outward from the shaft portion 387 of the anchor 386 in a direction that is disposed perpendicular to a direction in which the extension portions 394 extend radially outward from the shaft portion 387 of the anchor 386. As further described below, during assembly, the alignment tab 399 can be aligned with the second port 340 of the adapter 312, so that they extend outwardly relative to the central longitudinal axis 320 in a relatively equal direction (for example, both point outwardly from the same side of the intermediate axis 306, as shown). shown in Figures 21 and 22). In some embodiments, the knob 314 may be assembled to the proximal end portion 310 of the intermediate shaft (e.g., globe) 306 as follows. However, it should be noted that the assembly method described below is illustrative and alternative assembly methods may be possible. In some embodiments, during assembly, the sleeve member 391 may be mounted over and / or around the proximal end portion 310 of the intermediate shaft 306. The anchor 386 may then be positioned over and around the intermediate shaft 306, adjacent to the member. of sleeve 391. In some embodiments, when the intermediate shaft 306 rests on a relatively flat surface (e.g., a table), the delivery apparatus 300 can be positioned so that the radiopaque marker on the distal end portion 309 points upward. (e.g., away from the table, which would appear on the page plane in Figure 21) and the anchor 386 can be positioned so that the alignment tab 399 is pointed away from the user (e.g., the person assembling the apparatus), as shown in Figure 21. For example, in Figure 21, the flat surface of the table may be in the plane of the page. After this portion of the alignment is completed, the anchor 386 can be attached (e.g., via UV bonding) to the intermediate shaft 306 and the sleeve element 391 can then be placed over the radial extensions 389 of the anchor 386. In some embodiments, the assembly method may further include attaching the adapter 312 to the intermediate shaft 306 such that the second port 340 points in the same direction as the alignment tab 399 and / or the second port 340 and the alignment tab 399. they are aligned circumferentially, relative to a circumference of the intermediate axis 306 (Figures 21 and 22). In this way, during an implantation procedure, a user can learn an initial (e.g., home) position of the radiopaque marker on the distal end portion 309 of the delivery apparatus 300, within a patient. This may allow for easier and faster rotary placement of the radiopaque marker, and therefore the prosthetic valve, at the target implantation site, as further described below. The outer casing 382 can then be placed around the anchor 386 (Figure 22). In some embodiments, this may include placing the first housing portion 384 and the second housing portion 385 around the anchor 386 and coupling them together. Figures 102-107 show various views of another embodiment of a knob (or handle) 2500 that is configured to rotate the intermediate shaft 306 of the delivery apparatus 300 with the rotation of the knob 2500. The knob 2500 (which may be further referred to as a handle or valve rotation control (VRC)) may be similar in function to knob 314 (and include the same or similar internal components, as further described below), except that a housing Exterior 2502 of knob 2500 is larger and is configured to include or enclose an adapter (such as or similar to adapter 312). Therefore, in a specific embodiment, the delivery apparatus 300 of Figure 9 includes knob 2500 instead of knob 314. As shown in the perspective and side views of Figures 102 and 103, respectively, the knob 2500 may be mounted on the proximal end portion 310 of the intermediate shaft 306 and surround or include therein the adapter 312 (or other, adapter). similar). For example, as shown in Figures 102-107, knob 2500 is disposed around and encloses adapter 312 so that a user cannot grasp or rotate adapter 312 independently of knob 2500. In some embodiments, the outer casing 2502 may include one or more fastening elements 2504 configured to increase traction or grip for a user to turn the knob 2500. In some embodiments, as shown in Figures 102-107, the one or more fastening elements 2504 may be raised elements or features that extend radially outward from an outer surface of the outer casing 2502 and are spaced apart from each other about a circumference of the outer casing 2502. In alternative embodiments, the one or more fastening elements 2504 may be raised ridges and / or depressed indentations in the outer casing 2502. In some embodiments, to increase the ease of assembly of the knob 2500, the outer casing 2502 may be divided into two or more mating components. For example, in some embodiments, as shown in Figure 103 and the exploded view of Figures 104 and 105, the outer casing 2502 may comprise a first casing portion 2506 and a second casing portion 2508 that are configured to attach detachably to each other. For example, each of the first housing portion 2506 and the second housing portion 2508 may include a corresponding mating interface configured to couple the first housing portion 2506 and the second housing portion 2508 to each other. In this way, the first housing portion 2506 and the second housing portion 2508 can be coupled together, around the intermediate shaft 306 and the internal components of the knob 2500, thereby forming the knob (e.g. knob assembly) 2500. Similar to knob 314 of Figures 15-22, knob 2500 may comprise anchor 386 disposed within outer casing 2502 and configured to anchor (e.g., couple) knob 2500 to proximal end portion 310 of the intermediate shaft. 306 (as shown in the cross-sectional side views of Figures 106 and 107). For example, the anchor 386 is configured to engage about the intermediate shaft 306 and interact with the sleeve element 391, as described above with reference to Figures 15-22 (and shown in Figures 106 and 107). As described above with reference to Figures 15-22, the outer casing 1502 is configured to engage around and anchor 386 and be received and / or secured around a proximal end of the sleeve member 391. For example, similar to the casing exterior 382 of the knob 314, the outer casing 2502 may comprise a first opening 2510 (formed by the two halves of the outer casing 2502 when the two halves are coupled together) configured to receive and / or hold therein around the proximal end of sleeve element 391 (Figures 104-107). The outer casing 2502 may further include an internal cavity 2512 (at its proximal end) configured to receive the adapter 312 therein (Figures 104-107). The outer shell 2502 may include a second opening 2514 (formed by the two halves of the outer shell 2502 when the two halves are coupled together) that is configured to fit around the first port 338 of the adapter 312 (Figures 104-107). A proximal end of the first port 338 may extend proximally away from and away from a proximal end 2516 of the outer casing 2502 of the knob 2500. In some embodiments, the outer casing 2502 comprises a cap 2518 configured to engage around the proximal end 2516 when the first portion of The housing 2506 and the second housing portion 2508 are arranged together, thereby coupling the first housing portion 2506 and the second housing portion 2508 together and forming the closed outer housing 2502 (Figures 102, 103 , 106, and 107). The outer casing 2502 may further include an extension portion 2556 that extends outwardly at an angle from a main body of the outer casing 2502. A portion of the internal cavity 2512 may be formed within the extension portion 2556 and configured to receive the second port 340 of the adapter 312. In some embodiments, the extension portion 2556 may include a third opening 2558 (formed by the two halves of the outer casing 2502 when the two halves are mated together) that is configured to fit around the second portion 340 (Figures 104 and 107). An open end of the second port 340 may extend away from and away from the third opening 2558. In alternative embodiments, instead of receiving the adapter 312 within the internal cavity 2512, the adapter and the outer casing 2502 may be integrated together (e.g., formed or molded as one piece). Similar to the knob 314, as described above with reference to Figures 15-22, the outer casing 2502 of the knob 2500 may comprise one or more openings 395 that are disposed on an interior of the outer casing 2502 and configured to receive and engaging with the one or more extension portions 394 of the anchor 386 (Figures 104-106). In some embodiments, each opening 395 may be disposed in a radial extension member 2520 that extends from an inner surface of the outer casing 2502 (Figures 104-106). In some embodiments, as described above with reference to Figures 21-22, the anchor 386 may include the alignment tab 399 that may extend radially outward from the anchor 386 (Figures 104 and 107). As described above and as shown in Figures 104 and 107, during assembly, the alignment tab 399 can be aligned with the second port 340 of the adapter 312, so that they extend outwardly relative to the central longitudinal axis 320 in a relatively equal direction (for example, both pointing outward from the same side of the intermediate shaft 306, as shown in Figures 104 and 107). In some embodiments, knob 2500 may be assembled to the proximal end portion 310 of intermediate shaft (e.g., globe) 306 in the same or similar manner as knob 314, as described above with reference to Figures 15-22. . For example, in some embodiments, during assembly, the sleeve member 391 may be mounted over and / or around the proximal end portion 310 of the intermediate shaft 306. Then, the anchor 386 may be positioned over and around the intermediate shaft 306, adjacent to the sleeve element 391. In some embodiments, when the intermediate shaft 306 rests on a relatively flat surface (e.g., a table), the delivery apparatus 300 can be positioned so that the radiopaque marker on the distal end portion 309 points upward (e.g., away from the table) and the anchor 386 can be positioned so that the alignment tab 399 points away from the user. After this portion of the alignment is completed, the anchor 386 can be attached (e.g., via UV bonding) to the intermediate shaft 306 and the sleeve element 391 can then be placed over the radial extensions 389 of the anchor 386. In some embodiments, the assembly method may further include attaching the adapter 312 to the intermediate shaft 306 such that the second port 340 points in a same direction as the alignment tab 399 and / or the second port 340 and the alignment tab 399. They are aligned circumferentially, relative to a circumference of the intermediate axis 306. In this way, during an implantation procedure, a user can know an initial (e.g., home) position of the radiopaque marker on the distal end portion 309 of the apparatus. of supply 300, within a patient. This may allow for easier and faster rotary placement of the radiopaque marker, and therefore the prosthetic valve, at the target implantation site, as further described below. The outer casing 2502 can then be placed around the anchor 386 and adapter 312 (Figures 104107). In some embodiments, this may include placing the first housing portion 2506 and the second housing portion 2508 around and coupling them to the anchor 386, thereby coupling the distal ends of the first housing portion 2506 and the second. housing portion 2508 with each other. The capsule 2518 can then be coupled to the proximal end 2516 of the knob 2500, thereby coupling the proximal ends of the first housing portion 2506 and the second housing portion 2508 together. These connections may allow the first housing portion 2506 and the second housing portion 2508 to be contained together without using additional adhesive or fasteners. In some embodiments, the outer casing 2502 may comprise one or more indicators 2522 (e.g., markings) that indicate to a user which way to rotate the knob 2500 to align the radiopaque marker on the distal end portion of the delivery apparatus ( for example, marker 500 or any of the other markers described herein) with the guide being delivered through a center of a center of the delivery apparatus (for example, under fluoroscopy during an implantation procedure, as described in this description). For example, in some embodiments, each indicator 2522 may comprise a printed mark that includes a line representing the guide, a visual representation of the radiopaque marker on either side of the line (e.g., markers C as shown), and a arrow on each side of the line instructing the user which way to turn knob 2500 if the radiopaque marker does not appear aligned with the guide in the selected imaging view during the implantation procedure, as further described below. description (for example, during the method at 1308, as described below with reference to Figure 57). For example, if the radiopaque marker on the distal end portion of the implantation apparatus (e.g., marker 600 or other marker described herein) appears to be on a first side of the guide in fluoroscopic image view, the user can rotate the knob 2500 in a first direction (as indicated by a first arrow of the indicator 2522) and if the radiopaque marker appears to be on a second, opposite side of the guide in the image view, the user can rotate the knob 2500 in a second, opposite direction (as indicated by a second arrow on indicator 2522) to place the marker in alignment with the guide during the implantation procedure. In some embodiments, as shown in Figures 102 and 103, each of the first housing portion 2506 and the second housing portion 2508 may include one indicator 2522 and the two indicators 2522 (one in each housing portion ) can be arranged 180 degrees apart around the 2500 knob. In some embodiments, the presence of the knob 314 or the knob 2500 to rotate the intermediate shaft 306 to achieve a desired rotary positioning of the prosthetic valve at the target implantation site may reduce a possibility of the user containing and using the adapter 312. to rotate the intermediate shaft 306 and the prosthetic valve. Such force or torque applied to adapter 312 may result in damage to adapter 312. Additionally, by completely encapsulating or enclosing adapter 312 within knob 2500, as shown in Figures 102-107, a user is prevented from containing and torque adapter 312. In some embodiments, to further discourage a user from holding and rotating the adapter 312 to rotatably align the prosthetic valve, a portion of the adapter 312 itself may be rotatable relative to the intermediate shaft 306 and a remainder of the adapter 312. For example, Figures 23-27 show one embodiment of a proximal end portion 400 of a delivery apparatus, which includes an adapter 402 comprising a first port 404 and a second (e.g., inflation) port 406 that is configured to turn. In some embodiments, the proximal end portion 400 may be used as the proximal end portion of the delivery apparatus 300 of Figures 9 and 14. Additionally, in some embodiments, the proximal end portion 400 may include components similar to those described above. with reference to Figures 9 and 14, and are therefore similarly labeled in Figure 23. As shown in Figure 23, the proximal end portion 400 may include a handle (e.g., handle portion), such as the handle 302 described above with reference to Figures 9 and 14. However, in alternative embodiments, An alternative handle configuration may be possible. A rotating shaft, such as the intermediate shaft (e.g., globe) 306, may extend distally from the handle 302 (as shown in Figures 9 and 14) and have a proximal end portion 310 that extends proximally from the handle. 302 to adapter 402 (Figure 23). Additionally, a rotating knob 414 may be mounted on the proximal end portion 310 of the intermediate shaft 306, distal to the adapter 402. The knob 414 may be configured to rotate the intermediate shaft 306. In some embodiments, the knob 414 may be the knob 314, as described above with reference to Figures 15-22. The adapter 402 may further comprise an adapter body (e.g., body) 408. The adapter body 408 may be coupled (e.g., connected) to the proximal end portion 310 of the intermediate shaft 306 (Figures 23 and 26). For example, the adapter body 408 may include a first internal channel 410 (Figure 25) configured to receive a proximal end of the intermediate shaft 306 therein (Figure 26). In some embodiments, an additional adapter 442 may be disposed around the intermediate shaft 306, between the knob 414 and the adapter body 408 (Figures 23 and 26). The first port 404 may extend axially from the adapter body 408 (Figures 24-26). In some embodiments, the first port 404 may be directly and / or rigidly coupled to a proximal portion 412 of the adapter body. 408 defining a second internal channel 416 of the adapter body 408 (Figures 25-27). For example, in some embodiments, the first port 404 and the proximal portion 412 may be joined together (e.g., through welding or an adhesive) at joint 444 (Figure 25). In some embodiments, the first port 404 may be configured as a guide port that is adapted to receive a guide. For example, in some embodiments, a guide may be inserted into an opening 418 in the first port 404 and extend through the internal shaft 308, the internal shaft 308 received within and extending through the second internal channel 416 and the first channel internal 410. For example, as shown in Figures 26 and 27, a proximal end of the internal shaft 308 may be disposed and fitted within a distal channel 420 of the first port 404 (Figures 25-27). A guide can then be inserted into the opening 418 and extend through an internal lumen defined by the internal axis 308. The second port 406 may extend radially outwardly from the adapter body 408, in a direction that intersects a central longitudinal axis 422 of the adapter 402 and a central longitudinal axis (e.g., central longitudinal axis 320) of the delivery apparatus (Figure 25). In some embodiments, the second port 406 may extend radially outward from the adapter body 408 at an angle that is between 10 and 90 degrees from the central longitudinal axis 422. In some embodiments, the second port 406 may extend radially outward from the adapter body 408 in a direction that is perpendicular to the central longitudinal axis 422. The second port 406 is rotatably coupled to the adapter body 408. For example, as shown in Figures 25-27, the second port 406 may be rotatably coupled to the proximal portion 412 of the adapter body 408. In some embodiments, The second port 406 may include a base portion 424 disposed around the proximal portion 412 of the adapter body 408. A seal 426 may be disposed between the base portion 424 and the proximal portion 412 of the adapter body 408 (Figures 25-27). In some embodiments, seal 426 may be a circumferential or ring-like seal that extends around an outer surface of the proximal portion 412 of the adapter body 408 (e.g., around the circumference). In some embodiments, seal 426 may comprise one or more O-ring seals or a quad ring seal. The second port 406 may further include an internal channel (forming an internal lumen) 432 that extends from an opening 428 in the second port 406, through a portion of the shaft 430 of the second port 406, and through a portion of the base portion 424 connected to the shaft portion 430. The shaft portion 430 may extend radially outward from one side of the base portion 424. The proximal portion 412 of the adapter body 408 may include an annular groove 434 that defines an annular channel 436 that extends around at least a portion of a circumference of the proximal portion 412 of the adapter body 408 (as best seen in Figures 25 and 27). In some embodiments, the annular channel 436 may fluidly couple the inner channel 432 to an annular space 438 defined between the outer surface of the inner shaft 308 and the inner surface of the proximal portion 412 of the adapter body 408 (Figures 26 and 27). . In some embodiments, one or more openings 440 extending radially inward from the annular groove 434 may fluidly connect the annular space 438 to the internal channel 432 (Figures 25 and 27). The annular space 438 can be fluidly coupled to the annular space 336 defined between the outer surface of the inner shaft 308 and the inner surface of the intermediate shaft 306 (Figure 26). In alternative embodiments, the annular groove 434 may extend through a thickness of the proximal portion 412 of the adapter body 408 to fluidly couple the internal channel 432 with the annular space 438. In this way, fluid (e.g., inflation fluid) can flow from the internal channel 432, to the annular space 438, to the annular space 336, and into the unreliable balloon (e.g., balloon 318 described above with reference to the Figures 9-14), while allowing the second port 406 to rotate about the adapter body 408 (e.g., about the central longitudinal axis 422). As a result, a user may be discouraged from attempting to rotate the intermediate shaft 306 by rotating the adapter 402 (for example, since doing so may result in the second port 406 rotating around the adapter body 408). Additionally, rotating the second port 406 can prevent torque from being applied to the adapter body 408 and the first port 404, thereby increasing durability and longevity of the adapter 402 and preventing a joint between the adapter 402 and the shaft from being compromised. intermediate 306. As a result, a possibility of more effective and consistent deployment of the balloon (e.g., balloon 318) can be increased through the injection of an inflation fluid through the second port 406. In addition, having a second rotating port 406 may allow a user to place the second port 406 in a variety of positions (to inject inflation fluid) without causing undesired movement of the delivery apparatus. 9-27, delivery apparatus 300 and / or similarly configured delivery apparatus may include one or more features that facilitate rotary alignment of a radially compressed prosthetic valve disposed in a portion of the distal end of the delivery apparatus, at the target implantation site. As introduced above, it may be desirable to implant a prosthetic heart valve into a native valve with a delivery apparatus (such as the delivery apparatus 300 of Figures 9-14) so ​​that the commissures of the prosthetic heart valve align with the commissures of the native valve. In some embodiments, to facilitate the desired rotary positioning of the prosthetic heart valve relative to the native valve, a radiopaque marker that is visible under medical imaging may be disposed on or incorporated into a portion of the distal end portion (such as a polymeric body mounted on a distal end portion of a shaft) of the delivery apparatus that is disposed near the valve mounting portion (e.g., valve mounting portion 324) of the delivery apparatus, and by therefore the prosthetic valve radially compressed. As further described below, in some embodiments, the radiopaque marker may be configured to indicate a location of a selected commissure of the prosthetic valve after radially expanding the prosthetic valve through inflation of a balloon of the delivery apparatus (e.g., balloon 318 of Figures 9-11). Figures 28-34B show embodiments of a radiopaque marker disposed in or incorporated into a portion of a delivery apparatus, such as the delivery apparatus 300 shown in Figures 9-14. Although the delivery apparatus 300 is shown by way of example in Figures 28, 29, and 32A-32B, in alternative embodiments, the radiopaque marker may be disposed in or incorporated within a portion of an alternative delivery apparatus configured to deliver a prosthetic valve radially compressed to a target implantation site. In some embodiments, the portion of the delivery apparatus into which the radiopaque marker is disposed or incorporated may be a polymeric body mounted on a shaft at the distal end portion of the delivery apparatus. For example, the polymeric body may be one or more of a proximal flange, a distal flange (e.g., distal flange 326 in Figures 9-11), or a nose cone (e.g., nose cone 322 in Figures 9-11) mounted on an internal shaft of the delivery apparatus and / or on another polymeric body mounted on the internal shaft. Figure 28 shows a radiopaque marker 500 positioned e / o incorporated within a polymeric body of the distal end portion of a delivery apparatus (e.g., delivery apparatus 300 shown as an example in Figures 28 and 29). In some embodiments, as shown in Figure 28, the distal flange 326 of the distal end portion 309 of the delivery apparatus 300 may include the marker 500 disposed therein and / or incorporated therein. As shown in Figure 28 and explained above with reference to Figures 9-11, the non-reliable balloon 318 is disposed over (e.g., covers) the distal flange 326 and the valve mounting portion 324. The cone of The nose 322 is disposed at a distal end of the delivery apparatus 300 and is disposed adjacent (and distal to) the distal flange 326. As explained above, the valve mounting portion 324 is configured to receive a radially compressed prosthetic valve. thereon, around the balloon 318. The distal flange 326 may be configured such that when a prosthetic valve is mounted on the balloon 318 in a radially compressed state, at the valve mounting portion 324, the distal flange 326 resists the movement of the prosthetic valve relative to the balloon 318 in an axial direction (arranged along and relative to the central longitudinal axis 320 of the delivery apparatus 300). The nose cone 322 and / or the distal rim 326 may comprise one or more polymeric materials, and therefore may be referred to herein as polymeric bodies. In some embodiments, the distal end portion 309 of the delivery apparatus 300 may have additional polymeric bodies or components, such as a proximal flange disposed on an opposite side of the valve mounting portion 324 of the distal flange 326. Marker 500 may be configured to be visible under medical imaging. For example, the marker 500 may comprise a radiopaque material that is configured to be visible under medical imaging, such as fluoroscopy and / or other types of x-ray imaging. In some embodiments, the marker 500 may comprise a radiopaque material or other material that is configured to be visible under MRI, ultrasound, and / or echocardiogram. The polymeric body, such as the distal rim 326, in which the marker 500 is disposed and / or incorporated may be configured so that it is not radiopaque. As a result, the marker 500 may be more easily visible under imaging, as further described below with reference to Figure 29. Although the marker 500 is shown positioned and / or incorporated within the distal flange 326 in Figure 28, in alternative embodiments, the marker 500 may be positioned and / or incorporated within another polymeric body or component of the distal end portion 309. of the supply device. For example, in some embodiments, the marker 500 may be positioned and / or incorporated within the nose cone 322 or a proximal rim of a delivery apparatus (e.g., proximal rim 120 shown in Figure 3). The marker 500 may have various shapes or patterns. For example, although marker 500 is shown in Figures 28 and 29 as a dot, in alternative embodiments, marker 500 may be configured as a different shape or symbol, such as a circle, rectangle, star, square, triangle, X, or similar. Additional embodiments of the marker shape are described below with reference to Figures 30-34B. As shown in Figure 28, the marker 500 is disposed and / or incorporated within a portion of the distal rim 326. In some embodiments, the portion of the distal rim 326 in which the marker 500 is disposed and / or incorporated may be a portion of the distal flange 326 that is disposed closer to (e.g., adjacent to) the valve mounting portion 324 than a remaining portion of the distal flange 326. Therefore, when the radially compressed prosthetic valve is disposed in the valve mounting portion 324, the marker 500 may be disposed near and adjacent to the prosthetic valve. In some embodiments, as shown in Figure 28, the distal flange 326 may comprise the base portion 325 and the flared portion 331. The flared portion 331 may extend radially outward from the base portion 325, toward the mounting portion of the valve 324. The marker 500 may be disposed and / or incorporated within the flared portion 331, thereby orienting the marker 500 radially outward from an outer surface of the internal shaft 308. In alternative embodiments, the marker 500 may be disposed on and / or incorporated into the base portion 325. In some embodiments, as shown in Figure 28, the flared portion 331 may comprise the plurality of wings 330 (which may further be referred to as extension portions) extending radially outward from the base portion 325, at an angle relative to to the central longitudinal axis 320. The wings 330 may be spaced apart about a circumference of the flared portion 331. As shown in Figure 28, in some embodiments, the marker 500 may be placed on or incorporated into one of the wings 330. In some embodiments, the marker 500 may be centered on one of the wings 330, such that it is centered along the central longitudinal axis 320. In some embodiments, the marker 500 may be a single (e.g., the only) radiopaque marker disposed on the distal rim 326. In some embodiments, the marker 500 may be the only (or a single) radiopaque marker disposed in the distal end portion 309 of the delivery apparatus 300. In some embodiments, the distal end portion 309 of the delivery apparatus 300 may include additional radiopaque markers (in addition to marker 500). Arranging the marker 500 on or in the distal flange 326, or other polymeric body of the distal end portion of the delivery apparatus, may allow the marker 500 to be more visible under imaging, such as fluoroscopy, since a residue of the distal rim 326 may be less or not radiopaque, and, therefore, may be less, or not, visible in the fluoroscopic image. For example, as shown in the illustrative fluoroscopic image 550 of Figure 29, marker 500 is visible under fluoroscopy and stands out since the distal rim is not radiopaque (other than marker 500). In contrast, the prosthetic valve frame 552 is radiopaque and visible under imaging. Therefore, a radiopaque marker placed on and / or in the prosthetic valve itself may be more difficult to see under imaging since the valve frame appears relatively dark in image 550. As further shown in Figure 29, a guide 554 extending through a center of the distal end portion 309 of the delivery apparatus (e.g., through the internal lumen of the internal shaft 308) is visible under fluoroscopy. and the marker 500 is positioned radially outward from the guide 554 (for example, because the marker 500 is positioned in the flared portion 331 of the distal flange 326). This further increases the visibility of marker 500 under imaging during an implantation procedure. Additionally, as further described below, when the marker 500 is arranged in a direct rear or direct front portion of the imaging view, the marker 500 may appear to overlap the guide. Additionally, arranging the marker 500 on or in the distal rim 326 (or other polymeric body of the distal end portion of the delivery apparatus) may allow for more precise alignment with the commissures of the native valve. For example, as further described below, it may be desirable to rotatably align the marker 500 with a target commissure of the native valve, prior to crossing the leaflets of the native valve. Therefore, when rotating the distal end portion 309 of the delivery apparatus, which includes the distal flange 326 and the prosthetic valve, to align the marker 500 with the target commissure of the native valve, it may be advantageous for the marker 500 to be have as far away as possible! possible in the delivery apparatus so that it is placed as close as possible to the target commissure of the native valve. As shown in Figure 28, the distal flange 326 (and nose cone 322) is one of the most distal components of the delivery apparatus 300 and is disposed more distal than the radially compressed prosthetic valve (e.g., more distal than the valve mounting portion 324, as seen in Figure 28). Arranging the marker 500 on or in the distal flange 326 (or other polymeric body of the delivery apparatus that is positioned offset from the prosthetic valve, in the axial direction) further allows the marker 500 to move, in a circumferential direction, in a selected commissure of the prosthetic valve. For example, as further described below, since the prosthetic valve rotates with inflation of the unreliable balloon 318, the marker 500 may move in the circumferential direction of the selected commissure of the prosthetic valve to compensate for this rotation. As a result, after deployment of the prosthetic valve, the selected commissure of the prosthetic valve can be aligned with the target commissure of the native valve. If the prosthetic valve itself had a displacement marker, this may be confusing after valve deployment since the marker would be visible but would not actually mark the selected commissure of the prosthetic valve. Additionally, providing the marker 500 on or at the distal flange 326 (or other portion of the delivery apparatus, near the valve mounting portion 324) can avoid having to add an additional component to the relatively permanent implant (e.g., valve prosthetic). Additionally, changes to the marker 500 (e.g., design changes) in the delivery apparatus can be more easily implemented in the delivery apparatus than if the marker 500 were in the valve (e.g., due to valve testing). as a result of any of the prosthetic valve design modifications). During an implantation procedure, a selected imaging view (e.g., fluoroscopic imaging view) may be used to visualize the distal end portion of the delivery apparatus, which includes the marker 500 and the radially compressed prosthetic valve (e.g., frame 552) in relation to the surrounding native anatomy. Based on an existing knowledge of a location of a selected commissure of the native valve (in which the prosthetic valve will be implanted) within the selected imaging view, a user can rotatably align the distal end portion of the implant apparatus. delivery at the target implantation site, such that marker 500 is aligned with the known location of the selected commissure, in the selected imaging view, or such that marker 500 is arranged at a certain position within the image view. selected images (e.g., direct posterior) and deployment of the prosthetic valve in such orientation will result in a commissure alignment between the prosthetic valve and the native valve. For example, in some imaging views, the selected commissure of the native valve may be arranged directly posterior to the imaging view. Therefore, by aligning the marker 500 on the delivery apparatus with the direct posterior portion of the imaging view, the prosthetic valve can be implanted within the native valve with alignment of the commissure between the native valve and the prosthetic valve. Illustrative fluoroscopic image views obtained during a prosthetic valve implantation procedure and used to guide the delivery apparatus near the native valve are shown in Figures 58, 61, and 63, as further described below. To enable desired positioning of the marker within the selected image view, in some embodiments, the marker may be configured as an asymmetrical marker which is then aligned with a guide extending through the delivery apparatus, along an axis. central longitudinal of the delivery apparatus. For example, the asymmetric marker may be reflective asymmetric along an axis that is parallel to the central longitudinal axis of the delivery apparatus. In this way, under medical imaging, such as fluoroscopy, a position of the marker within the imaging view, relative to the guide, can be more easily discerned (e.g., a front vs. back imaging view). ). Figures 30-34B show illustrative embodiments of such an asymmetric marker that allows a user to differentiate between two different positions of the marker within the image view. For example, in some embodiments, the asymmetric marker is configured such that a user viewing the imaging view can differentiate between the marker being placed on a front portion or a back portion of the fluoroscopic imaging view. The markers shown in Figures 30-34B can be placed in the delivery apparatus, as described above with reference to Figures 28 and 29. For example, in some embodiments, the markers shown in Figures 30-34B can replace the marker 500 (Figures 28 and 29) on the distal rim 326 or an alternative polymeric body of the distal end portion 309 of the delivery apparatus. In some embodiments, the asymmetrical marker may be a letter of the alphabet (for example, as shown in the Figures 30-34B), a number, a symbol, a shape, or the like, which is the asymmetrical reflection along an axis that is parallel to the central longitudinal axis of the delivery apparatus. For example, the asymmetric marker may have a first orientation where it can be read correctly or forward (e.g., not backward) and a second orientation that is rotated approximately 180 degrees around the axis from the first orientation, resulting in the bookmark appears backwards to a reader (e.g. user). Figure 30 shows a first illustrative embodiment of an asymmetric marker 600 that is shaped like a letter C and may be configured similarly to marker 500 of Figure 28 (e.g., radiopaque). The C-shaped asymmetrical marker 600 is reflective asymmetrical along a longitudinal axis 602 which, when placed in a delivery apparatus (e.g., delivery apparatus 300), as described above with reference to Figure 28, is parallel to the central longitudinal axis of the delivery apparatus. For example, in Figure 30, the asymmetric C-shaped marker 600 is in a first orientation that is its readable forward orientation (e.g., it appears in its correct orientation, not backward, to a reader). If the asymmetrical C-shaped marker 600 were rotated approximately 180 degrees about its longitudinal axis 602, the asymmetrical C-shaped marker 600 would be in a second orientation and the C would appear backward (e.g., flipped). These two orientations of the asymmetric C-shaped marker 600 can be viewed in a medical imaging view (e.g., through the use of fluoroscopy), as further explained herein. The two orientations of the C-shaped asymmetric marker (and other asymmetric markers described herein) may be mirror images of each other. Figures 31A and 31B show illustrative fluoroscopic images 610 and 612, respectively, of a guide 606 extending through a distal end portion of a delivery apparatus (e.g., the distal end portion 309 of the delivery apparatus 300 ) and the asymmetric C-shaped marker 600 disposed at or incorporated within a portion of the distal end portion of the delivery apparatus (e.g., the distal flange 326, as shown in Figure 28). As shown in the first fluoroscopic image 610 of Figure 31A, the asymmetric C-shaped marker 600 aligns with (e.g., overlaps) the guide 606 and the C is readable, in its first (forward) orientation. In some embodiments, this position of marker 600 shown in Figure 31A may indicate that marker 600 is arranged behind the figure. 606 within the first fluoroscopic image view 610, and therefore in the direct rear of the image view. In alternative embodiments, the position of the marker shown in Figure 31A may indicate that the marker is disposed in front of the guide 606, and therefore, in the direct front of the imaging view. In contrast, when the delivery apparatus is rotated approximately 180 degrees from its orientation shown in Figure 31A, the C-shaped asymmetric marker 600 is correspondingly rotated and appears in its second orientation (rearward) where the C is towards the rear, as shown in Figure 31B. In some embodiments, the position of marker 600 shown in Figure 31B may indicate that marker 600 is disposed in front of guide 606 within the imaging view, and therefore in the direct front of the imaging view. . In alternative embodiments, the position of marker 600 shown in Figure 31B may indicate that the marker is disposed behind guide 606, and therefore in the direct rear of the imaging view. Thus, when viewing an orientation of a reflective asymmetric marker, such as marker 600, relative to guide 606, within a selected imaging view, the position of marker 600 at an implantation site (e.g., near the target native valve) can be determined more easily and quickly. Additional details on the rotary alignment of the marker relative to a guide such that the prosthetic valve is implanted with commissures aligned with the commissures of the native valve are explained below with reference to Figures 57-60. Figures 32A and 32B show a side view and perspective view, respectively, of an illustrative positioning of the asymmetric marker 600 (formed as the letter C) in and / or incorporated within the distal flange 326 of the distal end portion 309 of the apparatus of delivery apparatus 300. As shown in Figures 32A and 32B, the marker 600 can be placed on the distal flange 326 (for example, on a wing 330, in some embodiments) so that when the delivery apparatus is disposed within the vasculature of a patient, and a longitudinal imaging view similar to the view of image 550 in Figure 29 is used to visualize the delivery apparatus, the C shape of the marker 600 will be read in the rearward orientation when the marker 600 is in the direct front of the image view and marker 600 will be read in the forward orientation when marker 600 is placed in the direct rear of the image view. In alternative embodiments, the marker 600 may be oriented differently on the distal rim than it is. 100 shown in Figures 32A and 32B, so that the marker 600 is rotated by 180 degrees and is read in place in the forward orientation when the marker 600 is in the direct front of the imaging view. Figures 33-34B show a second illustrative embodiment of an asymmetric marker 650 that is shaped like a letter E and may be configured similarly to marker 500 of Figure 28 (e.g., radiopaque). Figure 33 shows the asymmetrical E-shaped marker 650 alone while Figures 34A and 34B show fluoroscopic images of the asymmetrical E-shaped marker 650, in a delivery apparatus, in two different orientations relative to the guide 606. The asymmetric E-shaped marker 650 may be configured and operated similarly to the marker 600, as described above with reference to Figures 30-32B, other than its general shape (e.g., E-shaped instead of C). For example, the asymmetrical E-shaped marker 650 may be reflectively asymmetrical across a longitudinal axis 652 that, when placed in a dispensing apparatus, is parallel to the central longitudinal axis of the dispensing apparatus. Similar to the marker 600, the asymmetrical E-shaped marker 650 has a first orientation that is its readable forward (or correct) orientation. 101 (as shown in Figure 33 and the first image 654 of Figure 34A). The asymmetric E-shaped marker 650 further has a second orientation, which is rotated approximately 180 degrees around its longitudinal axis 652 from the first orientation. In the second orientation, the E appears backwards (as shown in the second image 656 of Figure 34B). These two orientations of the asymmetric E-shaped marker 650 can be seen with medical imaging (e.g., fluoroscopy), as shown in Figures 34A and 34B and explained below in the present description. In some embodiments, the asymmetric E-shaped marker 650 may replace the marker 600 in the delivery apparatus shown in Figures 32A and 32B. In still other embodiments, an asymmetric marker may be formed as another letter (in addition to C or E, such as P or F), a number, a symbol, a shape or the like, which is reflectively asymmetric, as described above, and It has two differentiable orientations when it rotates approximately 180 degrees around its asymmetric reflection axis. In some embodiments, the asymmetric marker (e.g., marker 600 or marker 650) disposed on or incorporated within the distal end portion of the delivery apparatus (such as distal flange 326) may 102 understand a radiopaque material. In some embodiments, the radiopaque material comprises metal. In some embodiments, the asymmetric markers described herein may comprise tantalum. In some embodiments, the asymmetric markers described herein may comprise another type of radiopaque material or combination of materials, such as one or more of iodine, barium, barium sulfate, tantalum, bismuth, or gold. In some embodiments, the asymmetric markers described herein may comprise a platinum-iridium alloy. In some embodiments, an alloy ratio of the platinum-iridium alloy is 90:10. In some embodiments, the alloy ratio of the platinum-iridium alloy is in a range of 75:25 to 95:5. In some embodiments, the alloy ratio of the platinum-iridium alloy is in a range of 85:15 to 95:5. In some embodiments, instead of or in addition to being placed on the distal end portion of the delivery apparatus, a radiopaque marker may be placed on a prosthetic valve, such as at or near a commissure of the prosthetic valve, as shown in the Figures 35A-35P and 97-101E. As a result, a location of a selected commissure of the radially compressed prosthetic valve 103 can be identified by medical imaging during a valve implantation procedure and rotatably aligned with the native anatomy at the target implantation site. In embodiments where the radiopaque markers are disposed at both the distal end portion of the delivery apparatus (as described above) and the prosthetic valve (at or near the commissure, as described below), a first radiopaque marker in The delivery apparatus can be visualized during the valve implantation procedure to rotatably align the first marker with the native anatomy and deploy the prosthetic valve such that its commissure aligns with the commissures of the native valve. A second radiopaque marker can then be visualized on the prosthetic valve after implantation (for example, during future interventions to locate the commissures of the prosthetic valve and / or to confirm the location of the commissures of the prosthetic valve relative to the commissures of the prosthetic valve. the native valve). In some embodiments, the second radiopaque marker at the commissure of the prosthetic valve can be more easily visualized after radial expansion of the prosthetic valve (after implantation). An illustrative embodiment of a radiopaque marker 700 104 attached to a commissure 702 of a prosthetic valve 704 (which may be similar to any of the prosthetic valves described herein, such as prosthetic valve 10 of Figure 1 or prosthetic valve 50 of Figures 2A and 2B) , is shown in Figures 35A and 35B. Figure 35A shows the prosthetic valve 704 in a radially compressed configuration (e.g., state), such as when arranged around and curled over a delivery apparatus, and Figure 35B shows the prosthetic valve 704 in a radially expanded configuration ( for example, state). As introduced above with reference to Figures 2A and 2B and as shown in Figures 35A and 35B, in some embodiments, the commissures 702 of the prosthetic valve 704 may comprise a joint member 706 disposed across a cell (e.g. For example, commissure cell) 708 of the frame 710 of the prosthetic valve 704. In some embodiments, the attachment member may comprise a fabric, flexible polymer, or the like disposed across the cell 708. As explained herein, cell 708 may be formed by struts 712 of frame 710. Attachment member 706 may be disposed across cell 708 and secured to struts 712 of frame 710 forming cell 708 via fasteners 714 (e.g., sutures). . Additionally, the adjacent portions 105 of two leaflets 716 of the prosthetic valve 704 can be connected to the connection member 706 to form the commissure 702. In some embodiments, the commissure tabs of two adjacent leaflets 716 engage the joint member 706, on an inner surface (shown in Figure 35E, as described below) of the joint member 706, and the marker 700 is arranged on an outer surface 724 of the connecting member 706. The inner surface may be disposed opposite the outer surface 724, which faces the interior of the prosthetic valve 704. In some embodiments, as shown in Figures 35A and 35B, the marker 700 may be disposed in a central region of the commissure cell 708. For example, in some embodiments, the marker 700 may be sewn to a central region of the attachment member. 706 through one or more fasteners (e.g. sutures) 722. In some embodiments, the marker 700 may be formed and positioned to fit within the cell 708 when the frame 710 is in the radially compressed configuration, as shown in Figure 35A. In some embodiments, the commissure cell 708 may be disposed at an outlet end 718 of the prosthetic valve 704. In some embodiments, marker 700 comprises 106 tantalum, or other radiopaque material described herein or known in the art, which is formed or laser cut into a shape that is reflectively asymmetric across the axis, similar to as described above with reference to Figures 28 -34B. In some embodiments, the prosthetic valve 704 includes a skirt 720 (Figure 35B) disposed around the frame 710 of the prosthetic valve 704, at an inlet end of the prosthetic valve 704 (e.g., an end disposed opposite the outlet end 718). ). As shown in Figures 35A and 35B, when the commissure cell 708 is arranged at the outlet end 718 of the prosthetic valve 704, the commissure cell 708 including the marker 700 can be separated, in an axial direction, from the skirt 720. Figures 35C-35H show another illustrative embodiment of attaching a radiopaque marker 750 to a commissure within a cell 708 of a prosthetic valve. The prosthetic valve shown in Figures 35C-35H may be the same prosthetic valve 704 as shown in Figures 35A and 35B, and therefore Figures 35C-35H are labeled accordingly. However, in Figures 35C-35H, there are two attachment members disposed across the cell 708 and attached to the struts 712 that form the cell 708. The commissure tabs 754 of the leaflets 716 and the marker 750 can be sutured to different union members of the two 107 union members. For example, the attachment member 706 to which the commissure tabs 754 of the leaflets 716 are attached may be a first attachment member 706 (Figures 35C, 35D, and 35H) and the marker 750 may be attached to a second attachment member. 752 (Figures 35C-35G). Marker 750 may be similar to marker 700 and the other radiopaque markers described herein. For example, marker 750 may be configured (e.g., formed and sized) so that it fits within cell 708 when frame 710 is in the radially compressed configuration (e.g., as shown in Figure 35A). An illustrative embodiment of the marker 750 is shown in Figure 351. The marker 750 may be oval in shape with a first (upper) opening 726 and a second (lower) opening 728 configured to receive fasteners (e.g., sutures) to secure the marker. 750 to a union member, as further described below. In some embodiments, the marker may include more or less than two openings (e.g., one, three, four, or the like) for receiving fasteners. In some embodiments, the marker 750 may have a different shape configured to fit within the cell 708 when the frame 710 is radially compressed, such as one of the other shapes of markers and 108 embodiments described in the present description (for example, with reference to Figures 35A, 35B, and 35J-35P). In some embodiments, marker 750 may be formed as a letter of the alphabet (e.g., as shown in Figures 35A and 35B). In some embodiments, the marker 750 may be reflectively asymmetric along an axis that is parallel to a central longitudinal axis 760 of the frame 710 (e.g., as shown in Figures 35A and 35B). As shown in Figure 35C, the first attachment member 706 can be secured to the struts 712 that form the cell 708 through fasteners (e.g., sutures) 714. The commissure tabs 754 of two adjacent leaflets 716 can be attached to the first attachment member 706, on an inner surface 756 of the first attachment member 706, as shown in Figure 35H (commissure tabs 754 are identified by region 755 in Figure 35C). For example, the commissure tabs 754 may be sutured directly to the inner surface 756 of the first attachment member 706 or through one or more interlayers of fabric between the commissure tabs 754 and the first attachment member 706. As further shown in Figure 35C, the marker 750 is secured to the second attachment member 752 through one or more fasteners 758 (e.g., sutures) that may extend through the first opening 726 and the second. 109 opening 728 at marker 750 (Figure 351). In some embodiments, the marker 750 may be sewn, with fasteners 758, to a central region of the second attachment member 752. In other embodiments, the marker 750 may have another number of openings or a different shape configured to receive fasteners 758 for securing the marker 750 to the second attachment member 752. For example, in some embodiments, the marker 750 may be shaped like the ring. (for example, formed like the letter, O). Figure 35C shows the marker 750 attached to the second joint member 752, but before the second joint member 752 is assembled to the frame 710. Figure 35G shows the marker 750 and the second joint member 752 after the second Connection member 752 is placed in the commissure cell 708, so that the marker is arranged between the first connection member 706 and the second connection member 752, and is sutured to the frame struts with one or more sutures 762. Thus, opposite sides of the second joining member 752 are shown in Figures 35C and 35G. In some embodiments, as shown in Figure 35G, the second attachment member 752 may be arranged, relative to the frame 710, such that an exposed metallic material of the marker 750 faces toward the frame 710 and the outer surface 724 of the first union member 706. 110 Therefore, when the second attachment member 752 is arranged across the cell 708 and attached to the struts 712 that form the cell 708, as shown in Figure 35G, the marker 750 can be interleaved (e.g., arranged ) between the second joining member 752 and the first joining member 706. In some embodiments, the second attachment member 752 may comprise a fabric material, similar to or the same as the first attachment member 706. In some embodiments, the second attachment member 752 may be secured to the struts 712 through additional fasteners (e.g., sutures). In other embodiments, as shown in Figures 35D-35F, the second attachment member 752 and the first attachment member 706 may be secured to the struts 712 at the same time and with the same fasteners (e.g., sutures 762). For example, in some embodiments, after securing the commissure tabs 754 of two adjacent leaflets 716 to the first attachment member, an upper portion of the first attachment member 706 may initially be secured to an upper strut 712 of the cell 708 with a first suture 762a (Figure 35D). The second joining member 752, with the marker 750 secured thereto, can then be aligned with the first joining member 706 (Figures 35D and 35E). The first suture 762a can then pass through 111 both the first connection member 706 and the second connection member 752 and around the struts 712 on a first side of the cell 708 (Figures 35D-35G), thereby forming a load bearing connection line single from the top to the bottom of cell 708. Similarly, a second suture 762b can pass through both the first connection member 706 and the second connection member 752 and around the struts 712 in a second side of cell 708 (Figures 35E-35G), thereby forming another single load bearing tie line from the top to the bottom of cell 708. In this way, the second connecting member 752 is disposed outside the first connecting member 706 relative to an outer surface of the frame 710 and the central longitudinal axis 760 of the frame 710 (Figure 35C). As a result, metal contact on the frame between the marker 750 and the frame 710 and / or any abrasive contact between the marker 750 and an exterior (e.g., outer surface) of the frame 710 can be avoided. Furthermore, by securing the marker 750 to the second, outer joining member 752, contact between the marker 750 and the leaflets (which are secured to the first, inner joining member 706) is further prevented. In some embodiments, the marker 750 may be secured 112 to the struts 712 with a sewing pattern that prevents weaving of the leaflets 716. In some embodiments, the additional material provided by the second attachment member 752 can further protect the knot tails and sutures used to secure the tabs of commissure 754 to the first joining member 706, thereby making the commissure more robust and durable. As described above, due to its positioning on the frame 710 and its radiopaque nature, the marker 750 can provide identification (e.g., visibility) of the commissure during an implantation procedure, thereby allowing an alignment of the desired commissure, as described in the present description. Furthermore, such a radiopaque marker 750 may further provide identification of a commissure location of the prosthetic valve, following implantation and during any future interventional procedures. Figures 35J-35P show additional embodiments of radiopaque markers configured to attach to a commissure within a cell 708 of a prosthetic valve, attached to an additional attachment member which is then attached to the cell 708, or attached to an additional skirt. or fabric material, directly below a location of a commissure (e.g., as shown in Figure 35L). For example in 113 some embodiments, any of the markers shown in Figures 35J-35P can replace the marker 700 on the prosthetic valve 704 (Figures 35A-35B) or the marker 750 on the second union member 752 (Figures 35C-35H). Additionally, any of the markers shown in Figures 35A-35P may be attached to a skirt or additional fabric material, directly and / or axially downstream of the commissure location (as shown in Figure 35L). Illustrative markers shown in Figures 35J-35P have different shapes or configurations. In some embodiments, a shape of the marker and / or a mounting location on the valve for the marker can be selected based on a geometry and space constraints of the valve (e.g., frame cell size). In certain embodiments, one or more of the markers shown in Figures 35J-35P may be formed and sized to fit within cell 708, both when the prosthetic valve frame 710 is in its radially compressed and radially expanded configurations. Figure 35J shows an illustrative embodiment of a radiopaque marker 766 secured to attachment member 706 disposed across cell 708 of frame 710 with one or more fasteners (e.g., sutures) 768. As shown in Figure 35J, the marker 766 is arc-shaped, with its longest dimension arranged in the circumferential direction 114 (for example, across a cell width of 708). However, in alternative embodiments, marker 766 may be oriented differently within cell 708, such as with its longest dimension in the axial direction (e.g., as shown in Figure 35L, as described below). . Figure 35K shows an illustrative embodiment of a radiopaque marker 770 secured to attachment member 706 disposed across cell 708 of frame 710 with one or more fasteners (e.g., sutures) 772. Marker 770 is annular or shaped like a either. For example, the marker 770 may include a central opening 771 and the one or more fasteners 772 may extend through the central opening 771, around the marker 770, and through the material of the attachment member 706. In some embodiments, the marker 770 may be centered on the union member 706. Figure 35L shows an illustrative embodiment of a radiopaque marker 774 secured to fixation member 706 disposed across cell 708 of frame 710 with one or more fasteners (e.g., sutures) 775 and a radiopaque marker 776 secured to one or more skirts 778 extending across an inner surface of the frame 710 with one or more fasteners (e.g., sutures) 780. In some embodiments, the one or more skirts 778 may include a plurality of skirts 778, each secured to a edge 115 cusp of the corresponding leaflet 716 and bent to extend across the struts 712 of the frame 710 disposed between the cusp edges of the adjacent leaflets 716. Therefore, in some embodiments, the marker 776 may be secured to an overlapping portion 782 of two adjacent skirts 778 that is disposed axially below the commissure 702. In certain embodiments, the prosthetic valve 704 may have only one of the markers 774 and 776 secured to the frame 710. As shown in the embodiment of Figure 35L, the markers 774 and 776 are arranged to extend in a direction of the central longitudinal axis 760 of the frame 710 of the prosthetic valve 704 (for example, the longest dimension of the marker 774 and the marker 776 extends in the axial direction, relative to the central longitudinal axis 760. Marker 774 may be the same or similar to marker 766 shown in Figure 35J, but rotated so that its longest dimension extends in the axial direction. Each of the markers 766, 770, 774, and 776 (Figures 35J-35L) may include one or more mounting openings 784 configured to receive one or more fasteners (for example, fasteners 768, 772, 775, or 780) for securing the marker to the attachment member 706 or to the one or more skirts 778. As shown in Figures 35J-35L, the mounting openings 784 may be circular. However, in modalities 116 alternatives, the mounting openings 784 may have a different shape (e.g., elongated, rectangular, triangular, or the like) and / or size (e.g., a diameter or width less than a width of the marker). Figures 35M-35P show additional illustrative embodiments of radiopaque markers that are reflection asymmetric along an axis that is parallel to the central longitudinal axis of the frame 710 of the prosthetic valve 704. As a result, the markers shown in Figures 35M- 35P may provide an indication of a position of the commissure 702, relative to a guide (as explained herein), under fluoroscopic imaging. For example, Figure 35M shows an illustrative embodiment of a radiopaque marker 786 secured to attachment member 706 disposed across cell 708 of frame 710 with one or more fasteners (e.g., sutures) 787. Marker 786 comprises a cut or elongated opening 789 arranged on a first side of the marker 786 (in relation to a central longitudinal axis 790 of the marker 786). Therefore, on a second, opposite side of the marker 786 (across the shaft 790), the marker 786 comprises a portion of solid material 791. The one or more fasteners 780 extend through the opening 789, around the marker. 786, and towards the union member 706. Since the portion of 117 solid material 791 and opening 789 are arranged on opposite sides of marker 786, relative to axis 790, marker 786 is asymmetrical in reflection across axis 790. Figure 35N shows another illustrative embodiment of a radiopaque marker 792 secured to attachment member 706 disposed across cell 708 of frame 710 with one or more fasteners (e.g., sutures) 787 and configured similarly to marker 786 ( Figure 35M). For example, the marker 792 further includes an opening 789 disposed across the axis 790 of the marker 792 of the solid material portion 791. However, the opening 789 and the solid material portion 791 of the marker 792 have different shapes (e.g. , more elongated) than marker 786. In certain embodiments, the markers described above may be secured to the attachment member 706, in a region of or to the tissue of the leaflets (e.g., the commissure tabs 754 of the leaflets 716, as shown in Figure 35H). For example, the underlying commissure tabs of the leaflets 716 of the commissure 702 are depicted in the figures as a central, heavier cross-hatch region on the attachment member 706. In some embodiments, the markers may be configured to attach to the joining member 706, outside this tissue region, thereby avoiding placing additional fasteners or sutures in the tissue of the commissure tabs of the 118 valves. Figures 350 and 35P show illustrative embodiments of radiopaque markers that are secured to an additional attachment member (e.g., which may be fabric) and the additional attachment member is then secured to attachment member 706, outside of the underlying tissue region. 799. For example, Figure 350 shows an illustrative embodiment of a radiopaque marker 794 secured to an additional attachment member 793 by one or more fasteners (e.g., sutures) 797 that can extend through a central opening (or region of cut) 795 on the marker 794. The additional attachment member 793 may be secured directly to the attachment member 706, outside of the tissue region 799, by one or more fasteners (e.g., sutures) 796. As a result, the marker 794 may secured to the attachment member 706, through the additional attachment member 793, without securing the marker 794 itself directly to the attachment member 706. Similarly, Figure 35P shows another illustrative embodiment of the radiopaque marker 794 secured to an additional attachment member 798 by one or more fasteners (e.g., sutures) 797 that may extend through the central opening (or cut region). 795 at the marker 794. The additional joining member 798 can then be secured directly to the joining member 706 by the one or more 119 fasteners 796. As shown in Figures 350 and 35P, the additional joining member 798 has a diamond shape while the additional joining member 793 has a rectangular shape. Alternative shapes are possible for the additional joining members (e.g., circular, square, and the like). Illustrative methods for attaching a radiopaque marker 750 (or any of the other radiopaque markers described herein) to an attachment member configured to attach to the commissure tabs of two adjacent leaflets (thereby forming a commissure) and securing to the struts 712 of a cell 708 of a frame 710 of a prosthetic heart valve, as shown in Figures 35A and 35B, are presented in Figures 97-101E. Figures 97-99B show an embodiment where a radiopaque marker 750 is attached (e.g., sewn) directly to a attachment member 730. As shown in Figure 97, attachment member 730 may comprise first and second side portions. 732a, 732b projecting laterally from a central portion 734 (or central region). The joining member 730 may further comprise an upper tab 736 and a lower tab 738 projecting from the upper and lower edges, respectively, of the central portion 734. In the United States patent publication 120 no. 2018 / 0028310, which is incorporated by reference herein, further details are described regarding attachment members for securing the commissure tabs of leaflets adjacent to a cell of a frame of a prosthetic valve. As shown in Figure 97, the marker 750 is secured directly to the central portion 734 of the attachment member 730 by one or more sutures 740 (which form one or more knots on an exterior of the marker 750). The attachment member 730 can then be bent and secured to the commissure tabs of the leaflets so that the marker 750 is disposed on either a radially outward facing surface 742 (e.g., oriented away from the leaflets) of the connecting member 730 (Figures 98A and 98B) or a radially inwardly oriented surface (e.g., the surface disposed opposite the radially outward oriented surface 742 and oriented toward the commissure tabs of the leaflets) of the connecting member junction 730 (Figures 99A and 99B). For example, when the marker 750 is secured to the radially outward facing surface 742 of the attachment member 730, when secured to the cell 708, the marker 750 is oriented outward and away from the leaflets and the interior of the frame. 710 (Figure 98B). In contrast, when the marker 750 is secured to the radially inward facing surface of the member 121 of junction 730, when secured to cell 708, marker 750 is oriented inward toward the leaflets (Figure 99B). Therefore, as shown in Figures 99A and 99B, the marker 750 is arranged behind the joining member 730. Figures 100-101E show another embodiment where a radiopaque marker 750 is attached (e.g., sewn) to an elongated flap 744 (or extension) of a joining member 746. As shown in Figure 100, the joining member 746 is similar to the joining member 730 of Figure 97 except that it comprises the longer flap 744 (instead of the shorter upper tab 736) extending from the central portion 734. As shown in Figures 101A-101E, the Marker 750 may be attached to the flap 744 and the commissure formed with the attachment member 746 (such as the commissure 702 shown in Figures 32A and 32B) by one or more sutures (or other fasteners, the like) that are used to secure the commissure tabs of the leaflets adjacent to the attachment member 746 (as shown in Figure 35H). For example, the marker 750 may be placed on a first surface 748 of the fin 744 (Figure 100, which shows the marker 750 as transparent for the sake of illustration), over one or more openings in the fin 744. In the embodiment of Figures 100-101E, the flap 744 includes two openings, including a first opening 701 and a second opening 703, which can be separated based on a 122 separation between the first opening 726 and the second opening 728 of the marker 750 (for example, so that the first opening 726 overlaps the first opening 701 and the second opening 728 overlaps the second opening 703). The flap 744 can then be folded over an outer surface 705 of the central portion 734 of the connecting member 746, over sutures extending outwardly from the outer surface 705 that were used to connect the commissure tabs of the adjacent leaflets to the member of junction 746 (Figure 101A). As such, the marker 750 is sandwiched between a second (outer) surface 707 of the fin 744 and the outer surface 705 of the central portion 734 of the attachment member 746 (Figure 101A). The first sutures 709 can then be sent through the second opening 728 of the marker 750 and through the second opening 703 in the flap 744 so that they extend outward and away from the second surface 707 of the flap 744 (Figure 101B). Similarly, the second sutures 711 can be sent through the first opening 726 of the marker 750 and through the first opening 701 in the flap 744 so that they extend outward and away from the second surface 707 of the flap 744 (Figure 101B). In some embodiments, the free ends of the first sutures 709 can be sent through portions in 123 loop 713 of the first sutures 709 that are arranged on each side of the fin 744, below the fin 744 (Figure 101C). The first sutures 709 are then pressed against the flap 744, as shown in Figure 101D. The free (loose) ends of the first sutures 709 can then be tied (or knotted) together to secure a first portion (upper portion in the view of Figures 101A-101E) of the marker 750 to the attachment member 746 and the free ends ( loose) of each second suture 711 can then be tied (or knotted) together with a corresponding third suture 717 (of a pair of third sutures 717 arranged below the flap 744) to secure a second portion (e.g., bottom) of the marker 750 to the joining member 746 (Figure 101E). In some embodiments, the first sutures 709 may be tied in a single knot and a double knot, thereby forming a first knotted portion 715 (Figure 101E). Each second suture 711 may be tied in one single and two double knots with the corresponding third suture 717, thereby forming a second knotted portion 719 and a third knotted portion 721 on opposite sides of the first opening 701 (Figure 101E). In this way, the marker 750 can be secured to the flap 744 of the attachment member 746 with the same sutures (or similar attachment members) that were used to secure 124 the commissure tabs of the leaflets adjacent to an inner surface of the attachment member 746. This can simplify the assembly process of the prosthetic heart valve, thereby saving assembly time and costs. As introduced above, a prosthetic valve may be mounted around and radially compressed (e.g., curled) over a valve mounting portion of a distal end portion of a delivery apparatus (e.g., valve mounting portion 324 of the delivery apparatus 300 shown in Figures 9-11 and 32A32B), for delivery of the valve to the target implantation site (for example, a native heart valve). In some embodiments, an inflatable balloon of the delivery apparatus (e.g., balloon 318 shown in Figures 9-11 and 32A-32B) is folded and wrapped in a manner that more efficiently folds the balloon material to minimize the diameter of the folded balloon. . As a result, a diameter of the prosthetic valve, which is curled in the radially compressed configuration on the folded balloon, can be further minimized. Figure 36 shows one embodiment of a non-reliable balloon 818 folded around a portion of the distal end 809 of a delivery apparatus 800. The delivery apparatus 800 may be similar to the delivery apparatus 300 of the Figures 125 9-11 and includes one or more flanges 802 mounted on an inner shaft 808, the inner shaft extending distally from an intermediate shaft (e.g., globe) 806. The globe 818 covers a valve mounting portion 824 of the distal end portion 809 of delivery apparatus 800. The balloon portion 818 in the valve mounting portion 824 may include one or more axially extending folds or pleats 830. Such axial folds 830 may be firmly compressed to minimize the profile of the balloon 818 and the crimped prosthetic heart valve thereon. In some embodiments, a distal portion 832 of the balloon 818 may include one or more axial folds or folds 834 when the balloon 818 is in a deflated state ready for insertion into the vasculature of a patient. In some embodiments, a proximal portion 836 of the balloon 818 may include one or more axial folds or folds 838 when the balloon is in a deflated state ready for insertion into the vasculature of a patient. Axial folds 834, 838 may reduce the overall profile of the distal end portion 809 of the delivery apparatus 800 to facilitate passage of the delivery apparatus 800 through the introducer sheath and the vasculature of the patient. Additional details regarding the folding or wrapping of a balloon into a portion of the distal end of a delivery apparatus are described in the United States provisional application 126 no. 63 / 051,244, filed July 13, 2020, which is incorporated by reference in this description. In some embodiments, the balloon 318 of the delivery apparatus 300 shown in Figures 9-11, 28, and 32A-32B can be folded in a manner similar to that of the balloon 818, as described above. Figure 37 is an illustrative cross-sectional view of balloon 318 of delivery apparatus 300, wrapped and folded around internal shaft 308, at the valve mounting portion 324 of delivery apparatus 300. As shown in Figure 37, the balloon 318 includes a plurality of overlapping folds or folds 390 when it is in its deflated configuration and when a prosthetic valve is mounted and compressed radially around the balloon 318. The balloon 318 can be folded such that the folds 390 give as resulting in a minimized diameter of the folded balloon (e.g., in its deflated configuration) which can reduce a diameter of the radially compressed prosthetic valve when crimped thereon. As introduced above with reference to Figures 9-11, the distal end portion 309 of the delivery apparatus 300 may include a distal tip portion 328 mounted on the distal end of the outer shaft 304. For delivery of the prosthetic valve to the target implantation site, the outer axis 304 and the axis 127 intermediate (e.g., balloon axis) 306 can move axially relative to each other so that the distal tip portion 328 is disposed over a proximal end portion of the balloon 318 (e.g., proximal end portion 333, as shown in Figure 10). As a result, the distal tip portion 328 may act as a proximal flange on a proximal side of the valve mounting portion 324 and resist movement of the radially compressed prosthetic valve, proximally in the axial direction, during advancement of the valve. distal end portion of the delivery apparatus to the target implantation site. For example, in some embodiments, the intermediate shaft 306 may be pulled on the outer shaft 304 or the outer shaft 304 may be pushed on the intermediate shaft 306, thereby moving the proximal end portion of the balloon 318 toward an interior of the distal tip portion 328. In some embodiments, the distal tip portion 328 may include internal and / or external expansion cuts or slots that provide flexibility to the distal tip portion 328 and allow it to expand radially outward as it is expanded. moves over the proximal end portion of the balloon 318, thereby increasing its ability to act as a balloon flange and resist axial movement of the radially compressed prosthetic valve mounted around the balloon 318 in the valve mounting portion 324. 128 In some embodiments, expansion cuts of the distal tip portion disposed along an interior surface of the distal tip portion may extend axially along the interior surface (relative to the central longitudinal axis of the delivery apparatus). . However, these axially extending expansion cuts can cause problems when the axis of the balloon (e.g., intermediate shaft 306) on which the balloon 318 is mounted is rotated (since the balloon 318 rotates as a result of the rotation of the axis of the balloon), when the distal end portion of the delivery apparatus is rotatably aligned at the target implantation site, as described herein. For example, during rotation of the balloon or intermediate shaft, the folds of the folded balloon 318 (as described above with reference to Figures 36 and 37) may become stuck in the interior expansion cuts, which extend axially from the portion of distal tip. Examples of such axially extending expansion cuts can be found in US Patent No. 9,061,119, which is incorporated by reference herein. Therefore, it may be desirable to have a distal tip portion that is configured to expand radially over the proximal end portion of the balloon 318, while also allowing the balloon 318 to slide more easily. 129 within the distal tip portion, without the balloon folds becoming jammed, when the intermediate shaft of the delivery apparatus is rotated Figures 38-41 show one embodiment of the distal end portion 309 of the delivery apparatus where the outer shaft 304 includes a distal tip portion 900 mounted on the distal end of the outer shaft 304 and the globe 318 includes the radial depression 334 ( Figures 40 and 41) in certain configurations. In some embodiments, the distal tip portion 900 may be the distal tip portion 328 of Figures 9 and 11. The distal tip portion 900 may be configured as a flexible adapter that includes a flexible portion 912 and a coupling portion (may also be referred to as a straight portion) 914. The flexible portion 912 may extend from a distal end of the coupling portion 914. and configured to flex (e.g., expand radially outward) from the distal end of the engagement portion 914. The engagement portion 914 may engage and mount around the distal end of the outer shaft 304 (Figure 39). The flexible portion 912 may be conical and have an outer diameter that increases in a distal direction, from the distal end of the coupling portion 914 to a distal end of the flexible portion 912. 130 The flexible portion 912 may include a plurality of internal expansion cuts or slots 902 (further referred to herein as internal helical slots) and a plurality of external expansion cuts or slots 904 (further referred to herein as external helical slots). ) (Figures 38, 39, and 41). As shown in Figures 38 and 39, the internal expansion slots 902 are helical and curved about a central longitudinal axis 906, from a proximal end 908 of the flexible portion 912 (e.g., where the flexible portion 912 extends from the coupling portion 914) to a distal end 910 of the distal tip portion 900. The external expansion slots 904 may further be helical and curved about the central longitudinal axis 906, from the proximal end! 908 of the flexible portion 912 to the distal end 910 of the distal tip portion 900. In some embodiments, each slot of the internal expansion slots 902 may be curved from about 75 to about 110 degrees, from about 80 to about 100 degrees, or from about 85 to about 95 degrees about the central longitudinal axis 906. In some embodiments, each slot of the external expansion slots 904 can be curved from about 75 to about 110 degrees, so 131 approximately 80 to approximately 100 degrees, or approximately 85 to approximately 95 degrees around the central longitudinal axis 906. In some embodiments, the internal expansion slots 902 are spaced apart, and the external expansion slots 904 are spaced apart, about a circumference of the distal tip portion 900. In some embodiments, the internal expansion slots 902 are offset (e.g., displaced circumferentially) from the external expansion slots 904 such that a location where an external expansion slot 904 is depressed into an outer surface of the distal tip portion 900 is disposed between where two adjacent slots of the internal expansion slots 902 are depressed into an internal surface of the distal tip portion 900 (Figure 38). The internal expansion slots 902 and external expansion slots 904 are configured to allow the flexible portion 912 to flex radially outward as the distal tip portion 900 moves over a portion of the proximal end 333 of the balloon 318 (Figure 40), toward the valve mounting portion 324. Figure 41 shows the distal tip portion 900 disposed over the proximal end portion 333 of the balloon 318, during advancement of a radially compressed prosthetic valve 922. 132 (which may be similar to one of the prosthetic valves described herein), mounted on the valve mounting portion 324 of the delivery apparatus, through the vasculature of a patient and to the target implantation site. The helical shape and orientation of the internal expansion slots 902 can be configured so that during rotation of the intermediate shaft (balloon) 306 (for example, to achieve alignment of the commissure at the target implantation site, as described in the present description), the coupling between the folds of the balloon 318 (e.g., folds or folds 390 shown in Figure 37) and the internal expansion slots 902 are reduced, thereby allowing the balloon 318 to slide more easily along the inner surface of the distal tip portion 900 while the balloon 318 rotates within the distal tip portion 900. For example, the helical shape and orientation of the internal expansion slots 902 can prevent folds of the balloon 318 are immersed and trapped within the internal expansion slots 902, as the intermediate shaft 306, and therefore the balloon 318, is rotated. After crimping the prosthetic valve over the valve mounting portion 324 and advancing the distal tip portion 900 over the proximal end portion 333 133 of the balloon 318 (as shown in Figure 41), the fluid disposed within the proximal end portion 333 of the balloon 318 is displaced and pushed distally within the balloon 318. As a result, the distal end portion 332 of the balloon 318 may expand radially outward excessively and may cause the crimped profile (e.g., diameter) of the prosthetic valve 922 to increase. A larger crimped valve profile can result in greater resistance when the delivery apparatus is pushed into and through a charger and casing of a delivery assembly. Therefore, to reduce or prevent the increase in the crimped profile of the prosthetic valve 922, the distal end portion 332 of the balloon 318 may be formed with a radial depression 334 that depresses inwardly toward the central longitudinal axis 320 of the apparatus. supply (Figures 40 and 41). In some embodiments, the radial depression 334 may be depressed inward, relative to an outermost radial surface of the distal rim 326. For example, as shown in Figure 40, the distal end portion 332 of the balloon 318 may extend over a wider, flared portion 331 (e.g., which may be formed by wings 330) of the distal flange 326, then depress radially inward toward the base portion 325 of the distal flange 326, and then extend again 134 radially outward to a proximal end of the nose cone 322, thereby forming the radial depression. Figure 40 shows a state of the balloon 318, including the radial depression 334 in the distal end portion 332, before crimping the prosthetic valve over the valve mounting portion 324 and advancing the distal tip portion 900 over the portion of the proximal end 333 of the globe 318. After crimping the prosthetic valve over the valve mounting portion 324 and advancing the distal tip portion 900 over the proximal end portion 333 of the balloon 318 (as shown in Figure 41), the fluid disposed within the The proximal end portion 333 of the balloon 318 is displaced and pushed distally, within the balloon 318, to the distal end portion 332 of the balloon 318. The radially pressed, distal end portion 332 of the balloon 318 can then expand radially (e.g., partially inflate) as it receives fluid displaced to the expanded state 924 shown in Figure 41 (solid lines) and Figure 26 (dashed lines). The radial depression 334 can be configured (e.g., sized) so that the distal end portion 332 can receive the displaced fluid without radially expanding the balloon portion 318 within the valve mounting portion 324, thereby avoiding way that the 135 curly profile of the prosthetic valve 922 increase. Before inflating the balloon 318 to deploy the prosthetic valve 922 at the target implantation site, the distal tip portion 900 can be moved axially away from the prosthetic valve 922 and away from the balloon 318 (either by pulling the outer shaft 304 proximally relative to the intermediate shaft 306 or by pushing the intermediate shaft 306 distally relative to the outer shaft 304). The prosthetic valve 922 can then be deployed and expanded radially by inflating the balloon 918. When the balloon 318 is inflated (e.g., when the distal end portion of the delivery apparatus and the prosthetic valve have reached the target implantation site, such as the native valve), the balloon 318 is deployed (e.g., unwrapped). ) in its expanded state, thereby radially expanding the prosthetic valve to its radially expanded state. As the balloon 318 expands, and its folds or folds 390 unfold (Figure 37), the prosthetic valve expands radially and rotates by a predetermined (e.g., known) amount. For example, unfolding of the balloon folds 390 causes the prosthetic valve to rotate during balloon inflation. As such, the position of the radially expanded prosthetic valve is rotated from its position in the delivery apparatus before inflating the balloon. 136 318, in the predetermined amount (for example, 10°, 20°, 30°, or similar). In some embodiments, during manufacturing of the delivery apparatus, the balloon may be wrapped and / or folded in a consistent and / or standardized manner such that a consistent amount of rotation of the prosthetic valve occurs during valve deployment (e.g., for a plurality of delivery apparatus manufactured in the same manner). Therefore, it may be desirable to mount (e.g., crimp) the prosthetic valve in its radially compressed state onto the valve mounting portion of the delivery apparatus such that a selected commissure of the prosthetic valve is displaced from the marker (e.g. example, marker 500 of Figure 28, marker 600 of Figures 30-32B, or marker 650 of Figure 33-34B) in the delivery apparatus in the predetermined amount, or is based at least on the predetermined amount of rotation. In this way, the circumferential displacement between the marker and the selected commissure of the prosthetic valve can compensate for the valve rotation that occurs during balloon inflation and valve deployment. In some embodiments, the predetermined amount of displacement may be based at least partially on the envelope of the balloon and the resulting amount of valve rotation that occurs during inflation of the balloon. 137 For example, deploy the prosthetic valve when inflating the balloon, after aligning the marker on the delivery apparatus with the guide within a selected imaging view (for example, align the asymmetric marker with the guide so that the marker is arranged in the back of the selected imaging view), may cause the prosthetic valve to rotate and implant within the native valve with the commissures of the prosthetic valve in alignment with the commissures of the native valve (as described in more detail below). In some embodiments, the marker on the delivery apparatus may be configured to indicate a circumferential location of a selected commissure of the prosthetic valve after deployment of the valve. Figure 42 shows an example of the prosthetic valve 922 mounted in and around the valve mounting portion 324 of the distal end portion 309 of the delivery apparatus 300, in a radially compressed state, with a selected commissure (indicated by a dashed line in Figure 42) 930 circumferentially displaced from the marker 600 by a predetermined amount 932. As discussed above, with deployment of the prosthetic valve 922 through inflation of the balloon, the prosthetic valve 922 can rotate as it is expands radially, by the predetermined amount 932, so that 138 the selected commissure at 930 ends up aligning circumferentially with the marker 600. As a result, the selected commissure at 930 of the implanted prosthetic valve can be aligned with a selected commissure of the native valve. In alternative embodiments, the predetermined amount 932 of displacement may be different from the predetermined amount of inflation of the prosthetic valve with deployment through balloon inflation. For example, as further described below, the predetermined amount of displacement may be determined based on a desired imaging view selected to view the delivery apparatus in a heart during an implantation procedure (e.g., based on a known location of the target commissure of the native valve within the selected imaging view). In some embodiments, the predetermined amount of displacement may be determined based on both the selected imaging view and the predetermined amount of rotation of the prosthetic valve upon deployment. To mount and crimp the prosthetic valve onto the valve mounting portion of the delivery apparatus in a predetermined position and / or orientation (e.g., circumferential position and / or orientation) relative to the delivery apparatus (e.g., relative to the marker 139 radiopaque on the distal rim or other portion of the distal end portion of the delivery apparatus), a mounting assembly may be used. The mounting assembly may include a first component configured to interact with a non-kinked prosthetic valve (e.g., at least partially radially expanded) and a second component configured to interact with a portion of the distal end of the delivery apparatus (e.g., a portion disposed proximal and / or adjacent to the valve mounting portion). The first and second components of the mounting assembly may further be configured to interact with different sides of a curling device. As a result, the mounting assembly may contain the prosthetic valve in a predetermined orientation and / or predetermined position relative to the delivery apparatus within the curler. Then, after crimping the prosthetic valve onto the valve mounting portion of the delivery apparatus, the prosthetic valve can be arranged in the radially compressed configuration, in a predetermined position and orientation relative to the delivery apparatus. For example, the radially compressed prosthetic valve may be arranged in the delivery apparatus such that a selected commissure of the prosthetic valve is displaced circumferentially from the marker (or other desired reference mark) on the delivery apparatus by the amount 140 default (for example, as shown in Figure 42). Figures 43-52 show embodiments of various components that can be used in a mounting assembly configured to crimp a prosthetic valve (such as one of the prosthetic valves described herein) on a valve mounting portion of a device. supply (e.g., valve mounting portion 324 of supply apparatus 300) in a predetermined position and orientation. The prosthetic valve can be crimped to the valve mounting portion of the delivery apparatus in a variety of ways. In some embodiments, a crimping device, such as crimping device 1084 shown in Figures 43 and 44, may be used to crimp the prosthetic valve onto the valve mounting portion of the delivery apparatus. As further described below, the curling device 1084 may include mating interfaces, on opposite sides of the curling device 1084, that are configured to receive and engage corresponding mating interfaces on the first and second components of the mounting assembly. . Figure 43 illustrates a rear perspective view of the curling device 1084 (or a view from the proximal side of the curling device 1084) and Figure 44 illustrates a front perspective view of the curling device 141 curling device 1084 (or a view from the distal side of the curling device 1084). The curling device 1084 may include a base 1086, an actuator in the form of a handle 1088, and a channel 1090 for the prosthetic valve and delivery apparatus to be inserted. The curling device 1084 may include a proximal face 1092 that includes a proximal opening 1094 leading to the channel 1090. The proximal opening 1094 may be configured so that the delivery apparatus is inserted into the channel 1090 therethrough. In some embodiments, the proximal face 1092 may include a mating interface with mating structures 1096 in the form of cutouts that may be configured to engage with a positioning device 1072, for example, as shown in Figure 49. For example, the docking interface may include one or more docking structures 1096. The curling device 1084 may further include a rotating body 1098 configured to rotate with rotation of the handle 1088. The curling device 1084 may operate through a plurality of pressure surfaces 1000 that surround the channel 1090 and that are configured to apply a force compression to radially compress a prosthetic valve positioned within channel 1090 (e.g., prosthetic valve 922 shown in Figures 51 and 52, as further described below). Pressure surfaces 1000 142 may surround an axis 1002 of the channel 1090. The pressure surfaces 1000 may be configured such that when the rotating body 1098 is rotated, a body presses and moves the pressure surfaces 1000 toward the center of the channel 1090 and the diameter of the channel 1090 is reduced. channel 1090. The pressure surfaces 1000 may form an iris structure that allows the pressure surfaces 1000 to move toward the center of the channel 1090 and reduce the diameter of the channel 1090. A prosthetic valve placed within the channel 1090 will compress accordingly within the channel 1090, due to the radially compressed force of the pressure surfaces 1000 against the prosthetic valve. As shown in Figure 44, the curling device 1084 may include a distal face 1004 that includes a distal opening 1006 leading to the channel 1090. The distal face 1004 may include a mating interface, which may comprise a cutting portion 1008. In some embodiments, the cutting portion 1008 may be configured as a notch, groove, depression, or the like, in the distal face 1004. The cutting portion 1008 may be configured (e.g., formed) to receive an alignment device of a supporting body for the prosthetic valve (e.g., alignment member 1024 shown in Figure 45, as further described below). The distal opening 1006 can be configured so that a 143 portion of the delivery apparatus passes through it during a curling operation that is performed by the curling device 1084. The configuration of a curling device may be varied in alternative embodiments. To crimp the prosthetic valve over the valve mounting portion of the delivery apparatus, it may be desirable to maintain the leaflets (e.g., leaflets 60 of the prosthetic heart valve 50 shown in Figures 2A and 2B) in an open position during the crimping of the prosthetic valve to the delivery apparatus, thereby reducing the possibility of degradation of the leaflets and / or attachments of the leaflets to a frame of the prosthetic valve. Therefore, in some embodiments, a support body that is configured to support and / or maintain one or more leaflets of the prosthetic valve in an open position can be used as the first component of a mounting assembly that is configured to contain the prosthetic valve and place the prosthetic valve inside the curler. An illustrative support body 1010 is shown in Figure 45. The support body 1010 may be configured to be inserted into a curling device, such as the curling device 1084 shown in Figures 43 and 44, and may have a support portion 1012 configured to be placed between one or more leaflets of the prosthetic device and 144 the delivery apparatus (e.g., delivery apparatus 300) and to support the one or more leaflets in an open position. The support body 1010 may comprise the support portion 1012 and a coupling portion 1013 configured to receive within and / or engage the curling device. The support body 1010 may include a first end 1014 and a second end 1016. The support portion 1012 may include an outwardly facing support surface 1015 that is configured to receive the prosthetic valve thereon (e.g., an interface with valve leaflets). In some embodiments, as shown in Figure 45, the coupling portion 1013 may have a cylindrical shape with a cylindrical outer surface 1018. The coupling portion 1013 may extend from the first end 1014 to a first surface (e.g., oriented proximally) 1020 that may be disposed normal to a central longitudinal axis extending through a center of the support body 1010, from the first end 1014 to the second end 1016. The first surface 1020 may attach the coupling portion 1013 to the support portion 1012, which includes the support surface 1015. In some embodiments, the first surface 1020 may include an alignment element, such as a cavity 1022, which may be configured to receive a coupler (e.g., 145 coupling element) 1070 of a ring body (further referred to in the present description as an alignment ring) 1038, as shown in Figures 47 and 48. An alignment member 1024 may be disposed on the engagement portion 1013 and configured to rotatably align the support body 1010 with the curling device 1084. The alignment member 1024 may be positioned circumferentially on the engagement portion 1013, near the first end 1014, in a position that circumferentially aligns the support body 1010 in a predetermined position and orientation within the curling device 1084. In some embodiments, as shown in Figure 45, the alignment member 1024 may comprise a protrusion that extends axially outward from the first end 1014 toward the second end 1016 of the support body 1010. In other embodiments, the alignment member Alignment may have other configurations, such as a cavity or other alignment feature that is configured to mate with a corresponding mating interface of the curling device 1084 (e.g., cutting portion 1008 shown in Figure 44). For example, the alignment member 1024 can be configured to insert into the cutting portion 1008 on the distal face 1004 of the curling device 1084 to 146 rotatably align the support body 1010 with the curling device 1084. The alignment member 1024 may further be configured to allow the support body 1010 to slide distally out of the cutting portion 1008 during operation of the curling device 1084 . The support portion 1012 may extend from the first surface 1020 to the second end 1016. The support portion 1012 includes the support surface 1015. The support portion 1012, and therefore the support surface 1015, may have a shape conical tapering radially inward in a direction from the first surface 1020 to the second end 1016. For example, a diameter of the support portion 1012 may decrease from the first surface 1020 to the second end 1016. In some embodiments, the Support portion 1012 may have a conical shape, as shown in Figure 45. In alternative embodiments, support portion 1012 may have another shape that tapers as described above, such as hexagonal or pyramidal. In some embodiments, the support portion 1012 may have a larger diameter that is smaller than the diameter of the cylindrical coupling portion 1013. In some embodiments, a portion of the connector 1026 (Figure 45) may attach the support surface 1015 to the 147 first surface 1020 and may have an annular shape with a relatively constant diameter. The support surface 1015 may be configured so that the inner surfaces of the leaflets of the prosthetic valve contact and rest on the support surface 1015 when the prosthetic valve is placed around the support portion 1012 (as shown in Figure fifty) . The support surface 1015 may be configured to resist the leaflets from moving to a closed position when the prosthetic valve is placed around the support portion 1012 and within the curling device 1084. The conical shape of the support portion 1012, as described above, may allow the support body 1010 to slide distally, away from the curling device 1084, when the pressure surfaces 1000 of the curling device 1084 press on the support surface 1015. As such, the conical shape of the support portion 1012 can cause a pressure force applied by the pressure surfaces 1000 to move proximally along the conical shape of the support surface 1015, which thereby moving the support body 1010 distally and out of the curling device 1084. The support surface 1015 can maintain the leaflets in an open position as the contact surfaces 148 pressure 1000 press against the conical support surface 1015. In this way, the support body 1010 can be configured to slide axially away from the prosthetic valve during and as a result of the curling device 1084 curling the prosthetic valve. The support body 1010, for example, may be configured to be inserted into the channel 1090 of the curling device 1084 and slide axially in the opposite direction of the channel 1090 on the curling device 1084 that curls the prosthetic valve 922, and, therefore, can slide in an axially distal direction (as shown in Figure 52). As shown in Figure 45, the support body 1010 may include a central opening 1028 leading to a central channel 1030. The central opening 1028 and the central channel 1030 may be configured so that the delivery apparatus extends through the themselves. An internal surface of the support portion 1012 may define the central channel 1030. The central opening 1028 may be positioned at the second end 1016 and the central channel 1030 may extend from the second end 1016 to the first end 1014. In operation, the prosthetic valve 922 can slide distally on the support surface 1015 of the support portion 1012 of the support body 1010, with the 149 frame 940 of the prosthetic valve 922 that extends over the support surface 1015 and the internal surfaces of the leaflets 942 of the prosthetic valve are arranged against the support surface 1015 (Figures 50 and 51). To align the prosthetic valve 922 in a desired circumferential orientation around the support portion 1012, and to separate the prosthetic valve 922 from the first surface 1020 at a desired separation, a ring body (which may further be referred to as an alignment ring ) can be used and placed on the support body 1010. Figures 46 and 47, for example, illustrate perspective views, from different sides, of a ring body 1038 that can be used with the support body 1010. The ring body 1038 can be configured to engage and extend around the support body 1010. The ring body 1038 may include a first surface (which may be a proximally oriented surface) 1040 (Figure 46), a second surface 1042 oriented opposite the first surface 1040 (which may be a distally oriented surface) (Figure 47 ), and an outer (e.g., circumferential) surface 1044 oriented radially outward and connecting the first surface 1040 to the second surface 1042. The ring body 1038 can 150 include an inner surface 1046 oriented opposite the outer surface 1044 and oriented radially inward, the inner surface 1046 defining a central channel (e.g., aperture or aperture) 1048 of the ring body 1038. In some embodiments, an alignment guide may be placed on the ring body 1038 (Figure 46). The alignment guide may comprise one or more indicators 1050a—c (which may further be referred to as alignment markers) configured to indicate a desired circumferential (e.g., rotating) position of selected elements (e.g., commissures) of the prosthetic valve 922. in relation to the ring body 1038 (Figures 46, 48 and 50). Each indicator 1050a-c may further indicate the desired circumferential position of selected elements of the prosthetic valve 922 relative to the support body 1010 (for example, when the ring body 1038 is coupled to the support body 1010, as further described below with reference to Figures 48 and 50). Each indicator 1050a—c may comprise a mark, groove, raised element, or other form of indicator, on one or more of the first surface 1040, the second surface 1042, or the outer surface 1044 of the ring body 1038. One or more or each of the indicators 1050a—c, for example, may comprise a variation in the profile of 151 surface of the ring body 1038, such as a raised portion or a recessed portion (e.g., groove). The indicators 1050a—c shown in Figures 46-48 and 50, for example, each comprise portions recessed in the form of slots in the first surface 1040 and extending to the outer surface 1044. In some embodiments, the indicators 1050a— c may be additionally printed to vary a color of the respective indicator 1050a—c so that the indicator is easier to display. In some embodiments, the indicia 1050a—c may be printed solely on the ring body 1038 without the use of a surface profile variation (e.g., no grooves). The indicators 1050a—c may be circumferentially spaced apart from each other on the ring body 1038. In some embodiments, the indicators 1050a—c may be spaced equally apart from each other around the circumference of the ring body 1038. The circumferential position of each indicator 1050a—c may correspond to and indicate a desired position of one of the commissures of the prosthetic valve when the ring body 1038 is coupled to the support body 1010 and the prosthetic valve is disposed around the support portion 1012 of the support body 1010 (e.g. , as shown in Figure 50). As such, a user can place the ring body 1038 in the 152 support body 1010 and align the commissures 944a-c of the prosthetic valve 922 with the respective indicators 1050a—c (Figure 50). In some embodiments, the ring body 1038 may include one or more arms (which may further be referred to as body portions) 1052, 1054 each extending around and defining the central channel 1048 (Figures 46 and 47). Each arm 1052, 1054 may have an arcuate shape that forms the body of the ring 1038. Each arm 1052, 1054 may comprise half of the body of the ring 1038 or another amount as desired. The first arm 1052 may include a first end portion 1056 (Figure 46) and a second end portion 1058 (Figure 47), with the first end portion 1056 positioned on a turn 1060 (Figure 46) that engages the first arm 1052. to the second arm 1054. The second end portion 1058 of the first arm 1052 may include a coupler for coupling to the second arm 1054. The second arm 1054 may include a first end portion 1062 (Figure 46) positioned at the turn 1060 and a second end portion 1064 (Figure 47) placed in the coupler. The coupler (may further be referred to as a coupling interface) may comprise a cavity in the second end portion 1058 of the first arm 1052, and a protrusion in the second end portion 1064 of the second 153 arm 1054. The protrusion may extend into the cavity and may be held in position with a snap fit or other form of engagement. As such, the second end portions 1058, 1064 of the respective first arm 1052 and second arm 1054 can be configured to engage each other to together contain the ring body 1038. If desired, the ring body 1038 can be separated and removed from the support body 1010 by the second end portions 1058, 1064 that are separated from each other and the arms 1052, 1054 that rotate around the turn 1060 in an open position. For example, the ring body 1038 can be opened to be removed from the support body 1010 and can be closed to contain around and engage the support body 1010. As shown in Figures 46 and 47, a first lever (e.g., radial extension) 1066 may extend radially outward from the first arm 1052, and a second lever (e.g., radial extension) 1068 may extend radially outward from the second arm 1054. The first lever 1066 and the second lever 1068 can each be configured to be depressed to rotate the first arm 1052 or the second arm 1054 around the rotation 1060 to cause the ring body 1038 to move to the open position. The ring body 1038 may have an axial width 1071 that may define a clearance from the prosthetic valve. 154 from the first surface 1020 of the support body 1010 (Figure 46). As shown in Figure 47, the ring body 1038 may include a coupler 1070 that extends axially outward from the second surface 1042. In some embodiments, the coupler 1070 may be a protrusion configured to extend into the cavity 1022 of the body. support 1010 (Figure 45). In alternative embodiments, the coupler 1070 may have a differently shaped coupling feature configured to engage a corresponding feature on the support body 1010. The coupler 1070 may be positioned circumferentially relative to the cavity 1022 such that the ring body 1038 engages the support body 1010 in a desired circumferential alignment. In this way, the coupler 1070 and the cavity 1022 can rotatably align the ring body 1038 with the support body 1010 such that the prosthetic valve is aligned circumferentially in a desired orientation relative to the support body 1010 and the device. of curling. In operation, the ring body 1038 may be placed on and / or around the support body 1010, with the indicators 1050a—c positioned in a desired rotational alignment (e.g., circumferential) relative to the body. 155 support 1010 (Figure 48). The coupler 1070 shown in Figure 47, for example, may be received within the cavity 1022, which circumferentially aligns the ring body 1038 in a desired position relative to the support body 1010. In other embodiments, other coupling devices may be used. alignment to rotatably align the ring body 1038 with respect to the support body 1010 in the desired rotary alignment. The ring body 1038 may abut the first surface 1020 of the support body 1010. The ring body 1038 may be configured to abut the prosthetic valve 922 when the prosthetic valve 922 is placed on the support body 1010. As such, the Prosthetic valve 922 may be positioned on the support surface 1015 with one end of the prosthetic valve 922 abutting the first surface 1040 of the ring body 1038 and defining a position of the prosthetic valve 922 on the support surface 1015. The body The ring 1038 may consequently comprise a spacer configured to define a position of the prosthetic valve 922 on the support body 1010. In some embodiments, the ring body 1038 may be oriented in an open configuration with the arms 1052, 1054 open and then may be positioned over and around the support body 1010 with the arms 1052, 1054 closed. 156 to secure the ring body 1038 around the support body 1010. The ring body 1038 may be placed over the portion of the connector 1026 shown in Figure 45, for example. The prosthetic valve 922 can then be placed around the support portion 1012 and the support surface 1015, and abut against the first surface 1040 of the ring body 1038. The prosthetic valve 922 can be placed on the support surface 1015 with the commissures 944a -c aligned circumferentially with the indicators 1050a—c and an end of the prosthetic valve 922 abutting the first surface 1040 (Figure 50). The use of the ring body 1038 may allow the commissures 944a-c of the prosthetic valve 922 to be positioned in a desired circumferential orientation relative to the ring body 1038 and therefore relative to the support body 1010 (e.g., with relation to the alignment member 1024 of the support body 1010). The alignment member 1024 may then rotatably align the support body 1010 with the curling device 1084, and thereby position the commissures 944a-c of the prosthetic valve 922 in a desired rotary orientation within the curling device 1084. As a result, the prosthetic valve 922 can curl over the delivery apparatus in an orientation 157 predetermined circumferential in relation to the delivery apparatus (for example, in relation to a radiopaque marker in the delivery apparatus, as described in the present description). The support body 1010 and the ring body 1038 may each be part of an assembly or system (e.g., mounting assembly) for use in crimping a prosthetic valve having one or more leaflets to a delivery apparatus. . In some embodiments, the assemblies or systems may include a positioning device 1072 configured to engage a portion (e.g., distal end portion) of the delivery apparatus, proximal to the valve mounting portion. Figure 49, for example, illustrates one embodiment of such a positioning device 1072 positioned proximal to the valve mounting portion 324. The positioning device 1072 includes a body 1074 that includes a first portion 1076 and a second portion 1078 attached at a hinge 1080. The body 1074 may include a central channel 1082 in which an intermediate shaft 306 (or other portion of the shaft, such as the outer shaft 304) of the delivery apparatus may be placed, with the second portion 1078 rotating about the hinge 1080 to close the central channel 1082 and retain the delivery apparatus (e.g., the intermediate shaft 306) within the central channel 1082. 158 The body 1074 may further include a flange portion 1053 that includes one or more mating surfaces (e.g., interfaces) in flange forms 1051 (Figure 49) that are configured to engage the mating structures 1096 of the proximal face 1092. of the curling device 1084 (Figure 43). Positioning device 1072 may be used to engage the distal end portion 309 of the delivery apparatus and suspend the distal end portion 309 of the delivery apparatus in position within the channel 1090 of the curling device 1084 (Figures 51 and 52). The positioning device 1072 may accordingly contain the delivery apparatus separate from the pressure surfaces 1000 of the curling device 1084, as shown in Figure 51 for example. Additionally, the positioning device 1072 may be positioned axially along the delivery apparatus such that the valve mounting portion 324 is contained within a defined axial position within the channel 1090 of the curling device 1084. In some embodiments, Such a feature may further allow the distal flange 326 of the delivery apparatus to be positioned outside of the channel 1090 of the curling device 1084 and distal of the channel 1090 such that the distal flange 326 is not pressed by the pressure surfaces 1000 during curling. He 159 delivery apparatus may further be contained in a defined axial position relative to the prosthetic valve 922 positioned on the support body 1010 (Figure 51). An illustrative method of operating the systems described herein may include the following steps. The stages can be modified, excluded, or replaced through modalities as desired. Initially, the ring body 1038 may be placed on the support body 1010 in a configuration shown in Figure 48 for example. The ring body 1038 can be rotatably oriented on the support body 1010 in a defined position, for example, through the engagement of the coupler 1070 shown in Figure 47 with the cavity 1022 shown in Figure 48. As such, the Prosthetic valve 922 can be placed on the support surface 1015 with the commissures 944a-c of the prosthetic valve 922 aligned circumferentially with the indicators 1050a-c (as shown in Figure 50). The prosthetic valve 922 may abut against the ring body 1038. With the prosthetic valve 922 positioned on the support surface 1015, in the desired rotational alignment, the ring body 1038 can then be removed from the support body 1010, before crimping the prosthetic valve 922 to the delivery apparatus. For example, the 160 levers 1066, 1068 can be pressed to rotate the arms 1052, 1054 around the turn 1060 and open the ring body 1038. With the ring body 1038 removed, the support body 1010 can be inserted into the curling device 1084 with the prosthetic valve 922 positioned around the support portion 1012. Figure 51, for example, illustrates the prosthetic valve 922 positioned over and around the support portion 1012 and the support body 1010 inserted into the channel of the curling device 1084. The distal opening 1006 of the curling device 1084 can be configured so that the support body 1010 is inserted into the channel 1090. The channel 1090 of the curling device 1084 may be configured to receive the prosthetic valve 922, the support body 1010, and the distal end portion 309 of the delivery apparatus. With insertion of the support body 1010 into the channel 1090 of the curling device 1084, the alignment member 1024 can be aligned (e.g., received within) with the cutting portion 1008 of the curling device 1084. As such, the rotary orientation of the support body 1010 within the channel 1090 of the curling device 1084, and consequently the rotational orientation of the prosthetic valve 922 within the channel 1090 of the curling device 1084, can be set to the desired position. 161 With the support body 1010 and the prosthetic valve 922 inserted into the channel 1090 of the curling device 1084, the positioning device 1072 (or an alternative positioning device, as further described below) can be attached to the distal end portion. 309 of the delivery apparatus and then inserted into the proximal opening 1094 of the curling device 1084 (Figure 51). The flanges 1051 of the positioning device 1072 can be coupled with the corresponding coupling structures 1096. Figure 51 illustrates a cross-sectional view of the pressure surfaces 1000 in position around the channel 1090 of the curling device 1084, and the support body 1010 inserted into the channel 1090 with the prosthetic valve 922 positioned around the support portion. 1012 . As shown in Figure 51, the support portion 1012 of the support body 1010 extends axially within the channel 1090, toward the proximal opening 1094 of the curling device 1084. The support surface 1015 may be surrounded by the pressure surfaces 1000. The engaging portion 1013 of the support body 1010 may be disposed outside of and distal to the pressure surfaces 1000, and may be retained within the distal opening 1006 of the curling device 1084. The alignment member 1024 162 may extend proximally toward the cutting portion 1008 of the curling device 1084. In Figure 51, the valve mounting portion 324 of the delivery apparatus is positioned within the channel 1090 of the curling device 1084. The prosthetic valve 922 is positioned within the channel 1090 and around the valve mounting portion 324. of the supply device. The support body 1010 is positioned within the channel 1090 and between the prosthetic valve 922 and the delivery apparatus. The support body 1010 supports the prosthetic valve leaflets 922 in an open position. The distal end portion 309 of the delivery apparatus extends distally into the inner channel 1090 of the curling device 1084 and distally into the central channel 1030 of the support body 1010. When inserted into the curling device 1084, the positioning device 1072 can be coupled to the distal end portion 309 of the delivery apparatus, proximal to the valve mounting portion 324, and can be coupled with the coupling structures 1096 of the proximal face 1092. The positioning device 1072 can be attached to the distal end portion 309 of the delivery apparatus at a location such that the valve mounting portion 324 is positioned at a desired location within the channel 1090 and in relation to to the prosthetic valve 163 922. For example, as shown in Figure 51, the prosthetic valve 922 may surround the valve mounting portion 324. As described above, the rotary alignment of the prosthetic valve 922 relative to the distal end portion 309 of the delivery apparatus may be in a predetermined orientation and / or position, desired due to the previous use of the ring body 1038. With the distal end portion 309 of the delivery apparatus, the support body 1010, and the prosthetic valve 922 in a desired position within the channel 1090, the actuator of the curling device 1084 can be actuated to compress the prosthetic valve 922. For example , the handle 1088 can be rotated to rotate the rotating body 1098 and move the pressure surfaces 1000 radially inward against the prosthetic valve 922 (Figures 43 and 44). Figure 52, for example, illustrates that the pressure surfaces 1000 have moved radially inward to apply a compressive force to the prosthetic valve 922. The prosthetic valve 922 is crimped to the delivery apparatus, around the mounting portion of the valve 324, which uses the pressure surfaces 1000 of the crimping device 1084. As shown in Figure 52, in its radially compressed state, the prosthetic valve 922 has increased in length, in the axial direction. 164 Crimping the prosthetic valve 922 to the delivery apparatus may include applying a force to the support surface 1015 of the support body 1010 with the pressure surfaces 1000, thereby causing the support body 1010 to slide axially within of channel 1090, in the opposite direction of prosthetic valve 922 (Figure 52). For example, as described above, the conical shape of the support portion 1012 and the support surface 1015 may cause the support body 1010 to slide distally away from the channel 1090 and away from the pressure surfaces 1000. , as the pressure surfaces 1000 move radially inward. The support body 1010 is configured to be loosely coupled to the curling device 1084 and slide in a direction axially opposite of the channel 1090 on the curling device 1084 that curls the prosthetic valve 922. In some embodiments, the support body 1010 may be ejected from the distal opening 1006, as shown in Figure 52. The elongated shape of the alignment member 1024 may allow the alignment member 1024 to slide out of the cutting portion 1008. In embodiments, the support body 1010 may not be ejected, but may remain attached to the detent device. 165 curling 1084 during curling. The support body 1010, for example, can slide distally while a cord or other form of coupler keeps the support body 1010 attached to the curling device 1084 so that the support body 1010 does not fall. After the prosthetic valve 922 is crimped to the delivery apparatus, the positioning device 1072 can be disengaged from the coupling structures 1096 and moved outward from the proximal opening 1094, thereby moving the delivery apparatus outward and in the opposite direction of the crimping device 1084. The positioning device 1072 can then be removed from the distal end portion 309 of the delivery apparatus, with the prosthetic valve 922 crimped to the delivery apparatus. In this way, the use of a mounting assembly that includes the support body 1010 can allow the prosthetic valve leaflets 922 to remain in an open position during curling. Such a feature may reduce the possibility of degradation to the prosthetic valve 922 that occurs during crimping. Furthermore, the conical shape of the support surface 1015 may allow the support body 1010 to slide out of the curling device through radially inward movement of the pressure surfaces 1000, so that the body of 166 support 1010 automatically moves away from and away from the crimped prosthetic valve 922. The support body 1010 can automatically slide axially outward so that the support surface 1015 is not positioned between the prosthetic valve 922 and the contact surfaces. pressure 1000 after curling. In some embodiments, the system may be configured such that a separate mechanism slides the support body 1010 distally, such that a conical shape may not be used for the support surface 1015. For example, arms or gears or other form of coupler They can be attached to the support body 1010 to move the support body 1010 in the opposite direction of the prosthetic valve 922. In some embodiments, the mounting assembly may include a differently configured positioning device that is configured to engage one or more coupling structures (e.g., coupling structures 1096 of curling device 1084) arranged on one side of a curling device. Figure 53 shows another embodiment of a positioning device 1100 that can be used in a mounting assembly and coupled to a curling device and Figures 54 and 55 show side and perspective views, respectively, of the positioning device 1100 attached to the portion of the distal end 309 of the delivery apparatus 300, proximal to the 167 valve mounting portion 324. As shown in Figure 53, the positioning device 1100 may include a body 1102 that includes a first portion 1104 and a second portion 1106 rotatably coupled to each other via a hinge 1108. The body 1102 may include a central channel 1110 (Figure 53) which is configured to receive the intermediate shaft 306 (or another portion of the shaft, such as the outer shaft 304) of the supply apparatus 300 (Figures 54 and 55). The second portion 1106 of the body 1102 may include a flange portion 1112 that extends radially outward therefrom and is disposed at a distal end of the positioning device 1100. The flange portion 1112 may include one or more coupling elements that They are configured to engage with correspondingly formed mating features on a side surface (e.g., proximal face) of a curling device. In some embodiments, as shown in Figure 53, the coupling elements are configured as circumferentially extending extension portions 1114. In some embodiments, the extension portions 1114 may be spaced apart from each other around a circumference of the flange portion. 1112. In some embodiments, the flange portion 1112 may include one or more indication elements 1116 that may 168 indicate an orientation of insertion of the extension portions 1114 into the curling device. As shown in Figures 54 and 55, the positioning device 1100 is secured around the intermediate shaft 306 at a location proximal to and adjacent to a portion of the proximal end of the balloon 318. Alternative embodiments of mounting assemblies that are configured to crimp a prosthetic valve onto a delivery apparatus in a predetermined position and / or orientation relative to the delivery apparatus are described in International Patent Application No. PCT / US19 / 28831, which is incorporated by reference in this description. Figure 56 is a flow chart of an illustrative method 1200 for crimping a prosthetic valve in a radially compressed state to a distal end portion of a delivery apparatus, in a predetermined position and in a predetermined orientation relative to the delivery apparatus. . In some embodiments, method 1200 may use one or more components of the mounting assemblies described herein with reference to Figures 43-55. Method 1200 begins at 1202 by placing (e.g., placing) a prosthetic valve (e.g., prosthetic valve 10 of Figure 1, prosthetic valve 50 of 169 Figures 2A-2B, or prosthetic valve 922 of Figure 41) on an implant holding device such that one or more commissures of the prosthetic valve align with one or more corresponding alignment indicators or markers on an alignment ring (or body of the ring) attached to the implant holding device. The implant holding device may be configured to receive an at least partially expanded radially expanded prosthetic valve and contain the prosthetic valve in a desired circumferential orientation. In some embodiments, the implant holding device may be the support body 1010 of Figures 45 and 48 and the alignment ring may be the ring body 1038 of Figures 46-48 and 50. For example, in some embodiments, the method at 1200 may include rotatably aligning the prosthetic valve in a support portion of the support body such that one or more commissures of the prosthetic valve coincide and align with corresponding indicators on the ring body (e.g., as shown). shown in Figure 50). In alternative embodiments, the alignment ring may be one of the alignment rings shown in Figures 65-68. After aligning the commissures of the prosthetic valve in the implant holding device, method 1200 continues to 1204, which includes removing the alignment ring from the implant holding device, while the prosthetic valve 170 circumferentially aligned remains attached to the implant holding device. At 1206, the method includes attaching a positioning device to the delivery apparatus. In some embodiments, attaching the positioning device may include coupling a portion of the positioning device about an axis of the delivery apparatus, proximal to a valve mounting portion of the delivery apparatus and a proximal portion of a non-reliable balloon of the apparatus. of supply. In some embodiments, the positioning device may be coupled to and about the intermediate (e.g., balloon shaft) of the delivery apparatus (e.g., intermediate shaft 306, as shown in Figure 54). The positioning device may be one of the positioning devices described herein (for example, positioning device 1072 of Figure 49 or positioning device 1100 of Figures 53-55) or another positioning device configured to attach to the delivery apparatus and to a curling device and containing the delivery apparatus in a desired circumferential orientation relative to the curling device. For example, the method at 1206 may include coupling the positioning device to the delivery apparatus such that a radiopaque marker on the delivery apparatus 171 is contained in a desired circumferential orientation within the curling device, with engagement of the positioning device with the curling device. Method 1200 continues at 1208 and includes placing (e.g., arranging or engaging) the distal end portion of the delivery apparatus and the positioning device on a first (e.g., proximal) side of a curling device (e.g., curling device 1084 of Figures 43 and 44 or other curling device). For example, a flange portion of the positioning device that includes one or more coupling elements may be coupled to the first side of the curling device such that the one or more coupling elements engage one or more corresponding coupling elements on the first side of the curling device. As a result, the distal end portion of the delivery apparatus, coupled with the positioning device, can be disposed within the crimping device, with the valve mounting portion disposed within a portion of the crimping device configured to press against and curl the prosthetic valve. In this manner, the positioning device and valve mounting portion of the delivery apparatus can be received within the crimping device in a predetermined circumferential orientation and position. 172 At 1210, the method includes placing the implant holding device on a second (e.g., distal) side of the curling device. For example, the method at 1210 may include inserting the implant carrier device into the second side of the curling device such that an alignment member of the implant carrier device is inserted into and / or engages a corresponding coupling structure or element of the curling device. curly. In this manner, the implant holding device and the prosthetic valve disposed on the implant holding device can be received within the curling device in a predetermined orientation. For example, when both the implant holding device coupled to the prosthetic valve and the positioning device coupled to the delivery apparatus are coupled to the curling device, a selected commissure of the prosthetic valve can be displaced, in a circumferential direction relative to an axis. central longitudinal of the delivery apparatus, from a radiopaque marker (e.g., such as one of the markers shown in Figures 28, 18Ά-18Β, or 42) at the distal end portion of the delivery apparatus in a predetermined amount. At 1212, the method includes crimping the prosthetic valve in a radially compressed state on the valve mounting portion of the delivery apparatus through use of the crimping device. In some embodiments, curling the 173 prosthetic valve at 1212 may include crimping the prosthetic valve in its radially compressed state around an inflatable balloon, at the mounting portion of the valve. Additionally, in some embodiments, crimping the prosthetic valve at 1212 may include crimping the prosthetic valve in the radially compressed state in the valve mounting portion of the delivery apparatus while maintaining the predetermined amount of displacement between the radiopaque marker and the commissure. selected from the prosthetic valve (for example, as shown in Figure 42, as described above). As further described below, the predetermined amount of displacement may be determined (e.g., preselected) based on a desired or selected imaging view used to obtain images of the distal end portion of the delivery apparatus during an implantation procedure and rotatably align the prosthetic valve with native anatomy (e.g., to achieve commissure alignment). During curling at 1212, in some embodiments, the implant carrier device may automatically disengage from the prosthetic valve and / or the curling device (e.g., as described above with reference to Figures 51 and 52). At 1214, the method includes removing the distal end portion of the delivery apparatus, with the valve 174 prosthetic curled on it, of the curling device. The method at 1214 may further include removing (e.g., decoupling) the positioning device from the delivery apparatus. In this manner, the positioning device can be removably attached to the delivery apparatus and the implant holding device can be removably attached to the prosthetic valve, as described above. After removing the curling device, the delivery apparatus can then be prepared for insertion into a patient's vessel and navigation to the patient's heart. Figure 57 is a flow chart of an illustrative method 1300 for implanting a prosthetic valve into a native valve of a patient's heart with one or more selected commissures of the prosthetic valve in alignment (e.g., in a circumferential direction) with one or more corresponding commissures of the native valve. In some embodiments, method 1300 may be carried out with a delivery apparatus that is configured to deploy a radially compressed prosthetic valve mounted on a portion of the distal end of the delivery apparatus through inflation of a balloon of the delivery apparatus. An illustrative delivery apparatus 300 is shown in Figures 9-11. The delivery apparatus may include one or more of the components described herein to assist 175 to rotatably align the delivery apparatus at the implantation site (e.g., native valve) to achieve the commissure alignment described above. In alternative embodiments, method 1300 may be carried out with a delivery apparatus that is configured to deploy a radially compressed valve by axially moving a casing or capsule covering a radially compressed prosthetic valve relative to an axis of the delivery apparatus (and therefore move the capsule instead of inflating the balloon to deploy the prosthetic valve). Method 1300 begins at 1302 and includes receiving a prosthetic heart valve mounted on a distal end portion of a delivery apparatus, around an unreliable balloon of the delivery apparatus and in a radially compressed configuration, in a predetermined position and in an orientation predetermined relative to the delivery apparatus, such that a selected commissure of the prosthetic heart valve is displaced, in a circumferential direction relative to a central longitudinal axis of the delivery apparatus, from a radiopaque marker on the distal end portion of the apparatus supply in a predetermined quantity. In some embodiments, the predetermined amount is determined based on a selected image view as further described below with 176 reference to Figures 58-68. In some embodiments, as described above with reference to Figures 30-34B, the marker may be reflective asymmetric along an axis that is parallel to the central longitudinal axis. In some embodiments, the marker may be placed on a polymeric body of the delivery apparatus, such as a proximal rim, a distal rim, or a nose cone. In some embodiments, the marker is disposed in and / or incorporated into a flared portion of a distal flange of the delivery apparatus, the distal flange being disposed distal to the valve mounting portion of the delivery apparatus (e.g., as shown in Figures 32A-32B and 42). In some embodiments, the method at 1302 may include crimping the prosthetic heart valve onto the distal end portion of the delivery apparatus through the use of a mounting assembly, as described above with reference to the method of Figure 56. At 1304, the method includes advancing the distal end portion of the delivery apparatus toward a native valve of a patient's heart. In some embodiments, the method at 1304 may additionally include first inserting the distal end portion of the delivery apparatus into the vasculature of the patient with an inflation port of an adapter of the delivery apparatus oriented 177 towards a user (for example, the user performing the implantation procedure) to orient the radiopaque marker entering the patient so that it is oriented towards a table on which the patient is placed (for example, due to the arrangement of the adapter 312 and the rotary knob 314 relative to the marker, as described above with reference to Figures 15-22). After advancing the distal end portion of the delivery apparatus to a location near the native valve (e.g., within the patient's heart), the method continues at 1306 and includes visualizing, under fluoroscopy and for a selected imaging view , a position of the radiopaque marker at the distal end portion of the delivery apparatus relative to a guide extending across an axis of the delivery apparatus. For example, as described above with reference to Figures 29, 31A-31B, and 34A-34B, through the use of medical imaging, such as fluoroscopy, the radiopaque marker can be visualized, along with the guide and additional components (for example, the valve frame of the prosthetic valve mounted on the delivery apparatus). A position of the radiopaque marker relative to the guide can be seen in the selected imaging view (for example, the marker may appear radially offset from the guide when it is not directly in front of the guide). 178 or behind the guide in the image view, as shown in the example in Figure 29). Therefore, since fluoroscopy does not provide perspective to naturally differentiate what is in the front versus the back of the selected imaging view, this perspective can be provided by viewing an asymmetric marker position relative to the guide, as further described below. As further described below with reference to Figures 61-64, a user can select from a plurality of possible image views to obtain images of the heart and the position of the distal end portion of the delivery apparatus relative to the valve. native. For each imaging view, a location of a target commissure of the native valve that should be aligned with a selected commissure of the prosthetic heart valve (after implantation) may be known within the selected imaging view. Shown in Figure 58 is an illustrative fluoroscopic image 1400 of a native (e.g., aortic) valve 1402 viewed with a more standard, three-cusp imaging view. As shown in Figure 58, the native aortic valve 1402 includes three leaflets: the non-coronary cusp 1404, the right coronary cusp 1406, and the left coronary cusp 1408. In the three-cusp view, the non-coronary cusp 1404 and the coronary cusp 179 left 1408 are arranged opposite each other in view and each is overlapped by a portion of the right coronary cusp 1406. As such, a commissure between the non-coronary cusp 1404 and the left coronary cusp 1408 is known to be located in the back of image 1400. At 1308, the method includes, before crossing the native valve, rotating the shaft of the delivery apparatus, which rotates the prosthetic heart valve and the marker, until the marker is centered along the guide and is in a predetermined orientation in the selected image view. The method at 1308 may be performed while imaging the heart and displaying the selected imaging view. In some embodiments, the default orientation in the selected image view is a direct rear of the image view (e.g., away from the viewer). In alternative embodiments, the default orientation in the selected image view may be a direct front of the image view (e.g., towards the viewfinder). Therefore, in some embodiments, the radiopaque marker may be configured as an asymmetric marker having a first orientation when in front of the guide (e.g., in the direct front of the imaging view) and a second, different orientation when is behind the guide (for 180 example, on the direct back of the image view). In this way, the asymmetrical marker can help a user differentiate between the marker that is placed in the front and the back of the selected image view (compared to a symmetrical marker that would appear the same to a viewer on a image view, whether the marker is behind or in front of the guide). For example, in some embodiments, as shown in Figure 59, the asymmetric marker 600 can be configured as a letter of the alphabet that appears readable forward (for example, C readable forward, as shown in Figure 31A) when the marker is centered along the guide 606 and is arranged in the direct rear of the imaging view (e.g., behind the guide, as shown in Figure 59) and appears to the rear (e.g., C towards back, as shown in Figure 31B) when the marker is centered along the guide and arranged in the direct front of the imaging view. Therefore, the method at 1308 may include rotating the shaft of the delivery apparatus, which rotates the prosthetic heart valve and the marker, until the marker appears centered along the guide and in its forward orientation, within the selected image view, thus placing the bookmark at the back 181 directly from the image view. In alternative embodiments, the asymmetric marker may appear forward when the marker is centered along the guide and is arranged in the direct front of the imaging view (e.g., in front of the guide) and appear rearward when the marker is centered along the guide and is arranged in the direct back of the image view. Therefore, in these embodiments, the method at 1308 may include rotating the shaft of the delivery apparatus, which rotates the prosthetic heart valve and the marker, until the marker appears centered along the guide and in its rearward orientation. , within the selected image view, thereby placing the marker directly behind the image view. In still other embodiments, the method at 1308 may include rotating the shaft of the delivery apparatus, which rotates the prosthetic heart valve and the marker, until the marker appears centered along the guide and is in a predetermined orientation (backwards). or forward) within the selected image view, thereby placing the marker in the direct front of the image view. In this way, the predetermined offset between the selected commissure of the prosthetic heart valve and the marker on the delivery apparatus 182 can be determined based on both the selected imaging view and the target orientation of the marker in the selected imaging view (direct front or direct back). By rotating the distal end portion of the delivery apparatus before crossing the native valve, blood flow through the native valve (which may be stoned) cannot be occluded by the delivery apparatus. Additionally, in some embodiments, if the crimped prosthetic valve were rotated within (e.g., through) the native valve (which may have calcified leaflets), emboli could be generated by removing pieces of calcium from the leaflets, which could lead to stroke or other medical complications. Therefore, by rotating the distal end portion of the delivery apparatus and radially compressing the prosthetic valve away from the native valve (e.g., in the ascending aorta), emboli and other complications can be reduced or avoided. Additionally, a user may take longer to rotate since the delivery apparatus is not in a position that can occlude blood flow through the native valve. After achieving the desired rotary positioning of the radiopaque marker relative to the guide at 1308, the method continues at 1310, which includes advancing the portion 183 of the distal end of the delivery apparatus that includes the prosthetic heart valve radially compressed through and into the native valve and inflate the balloon to radially expand and implant the prosthetic heart valve in the native valve so that the selected commissure of the heart valve The prosthetic valve is aligned with the target commissure of the native valve. In some embodiments, during inflation, as the prosthetic heart valve expands radially, the prosthetic heart valve rotates by an amount equal to the predetermined amount of displacement between the marker and the selected commissure when the prosthetic heart valve is compressed radially around of the globe. For example, as shown in the illustrative schematic of Figure 60, when the target commissure 1450 of the native valve 1452 is known to be in the direct posterior part of the selected imaging view used for rotary positioning at the implantation site , and the marker 600 is aligned in the direct back of the selected image view, the prosthetic valve 922 can rotate by an amount (as shown by arrow 1454 in Figure 60) that is equal to the predetermined amount of displacement between the marker and the selected commissure 930 of the prosthetic valve 922 when the prosthetic heart valve is compressed radially around the balloon, which implants 184 in this way the prosthetic valve 922 with the selected commissure 930 aligned circumferentially with the target commissure 1450 of the native valve 1452. In alternative embodiments, during inflation, as the prosthetic heart valve expands radially, the prosthetic heart valve rotates by an amount that is more or less than the amount of displacement between the marker and the selected commissure when the prosthetic heart valve is rotated. compresses radially around the globe. However, this amount of displacement can be predetermined based on the selected imaging view and preexisting knowledge of a location of the target commissure of the native valve within the selected imaging view. In this way, during method 1300, the marker on the delivery apparatus can still be aligned with the guide (for example, in the direct back of the selected image view), but the predetermined amount of displacement between the marker and the Selected commissure of the radially compressed prosthetic valve can be adjusted for a different imaging view so that, upon inflation of the balloon, the prosthetic valve rotates and is implanted with commissures in alignment with the commissure of the native valve. Examples of this rotary alignment and circumferential offset adjustment are described below. 185 between the marker on the delivery apparatus and the selected commissure of the radially compressed prosthetic heart valve, for different image views, with reference to Figures 61-68. Shown in Figure 61 is a schematic of a first embodiment of a more standard imaging view of three cusps 1500 of a native valve 1510 that can be used to visualize the delivery apparatus in a patient's heart during an implantation procedure. and rotatably aligning the prosthetic valve, as described above. In the three-cusp image view 1500, the non-coronary cusp 1502 of the native valve (e.g., aortic valve) 1510 and the left coronary cusp 1504 are arranged opposite each other in the view and each overlaps by a different portion of the right coronary cusp 1506, with the three cusps aligned along a transverse axis 1508. Therefore, as shown in the cross-sectional view of the native valve 1510 in Figure 62, for the image view of Figure 62 also shows the direct front part 1516 of the image view, in the 186 which is located the right coronary cusp 1506. In contrast, Figure 63 shows a schematic of a second embodiment of a different right / left cusp overlap view 1550 of the native valve 1510 that can be used to visualize the delivery apparatus in the patient's heart during an implantation procedure. and rotatably aligning the prosthetic valve, as described above. In the right / left cusp overlap view 1550, the left coronary cusp 1504 and the right coronary cusp 1506 overlap each other and the non-coronary cusp 1502 is displaced from the left coronary cusp 1504 and the right coronary cusp 1506. As shown shown in the cross-sectional view of the native valve 1510 in Figure 64, for the right / left cusp overlap view 1550, the selected commissure 1512 is displaced circumferentially from the direct posterior part 1514 of the imaging view. It should be noted, in alternative embodiments, a different commissure of the native valve (in addition to the commissure disposed between the non-coronary cusp and the left coronary cusp) may be based at least partially on the selected commissure of the predetermined offset between the marker and the commissure. selected prosthetic valve. 187 Therefore, for the two different image views shown in Figures 61 and 63, the circumferential displacement between the radiopaque marker on the delivery apparatus and the selected commissure of the radially compressed prosthetic valve may be of different predetermined displacement values. In some embodiments, the implantation procedure can continue in the same manner for the different image views (for example, the method at 1304, 1306, 1308, and 1310 can continue as described above, by using the different image views. selected images), which includes rotatably aligning the radiopaque marker on the delivery apparatus with the guide such that the marker is positioned directly posterior to the imaging view (e.g., as shown in Figures 59 and 60). However, the mounting of the prosthetic valve to the delivery apparatus can be adjusted such that a different amount of circumferential displacement is used between the marker and the selected commissure of the prosthetic valve for the different procedures using the different imaging views, where The given amount of circumferential displacement for the selected imaging view results in the prosthetic valve being implanted in the native valve with commissures in alignment with the commissures of the native valve. 188 It should be noted that the two image views shown in Figures 61 and 63 are examples of two different image views that could be used during a valve implantation procedure to rotatably align the prosthetic valve on the native valve. However, additional imaging views that place a target commissure of the native valve in a different location relative to the direct posterior (or front) of the selected imaging view are possible and may additionally be used with the systems and methods described in this description. In this way, a user can select from a plurality of possible image views and the circumferential location of the selected (or target) commissure (for example, commissure 1512 shown in Figures 62 and 64) relative to the posterior (or front) of the selected image view can be known (e.g., default). In some embodiments, different alignment rings (e.g., ring bodies, similar to ring body 1038 shown in Figures 46-48) for a mounting assembly or different indicators on an alignment ring that denote an alignment location for one or more commissures of the prosthetic valve arranged in an implant holding device (for example, such as the support body 1010 of Figures 45 and 48) can be used to 189 different views of images selected for the valve implantation procedure. Figures 65-68 show illustrative embodiments of different alignment rings that can be used in a mounting assembly and are configured to rotatably align the prosthetic valve in an implant holding device, thereby resulting in the prosthetic valve being aligned. curl on a valve mounting portion of a delivery apparatus in a predetermined circumferential orientation relative to a radiopaque marker on the distal end portion of the delivery apparatus. For example, the alignment rings may be configured such that the prosthetic valve is radially compressed onto the delivery apparatus with a circumferentially offset selected commissure of the radiopaque marker at the distal end portion of the delivery apparatus by a predetermined amount that is determined ( for example, is selected) based on the image view selected for use during an implantation procedure. In some embodiments, as shown in Figures 65 and 66, the different alignment rings may be similar in general form and function, but have a different arrangement of indicators or markers that are unique to a selected image view intended to be used. . For example, the different alignment rings that 190 have a unique arrangement of indicators or markers can be configured to align the prosthetic valve in an implant holding device in such a way as to displace a selected commissure of the prosthetic valve relative to the radiopaque marker in the delivery apparatus by the appropriate amount that aligns the commissures of the prosthetic valve with the native valve when the prosthetic valve is deployed from the delivery apparatus with the radiopaque marking aligned with the guide as described above. Figure 65 shows an embodiment of an alignment ring 1600 that can be configured to rotatably align a prosthetic valve relative to a delivery apparatus for an implantation procedure using a first view of images, such as the view of tri-cusp images (e.g., tri-cusp imaging view 1500 of Figure 61), to rotatably align and implant the prosthetic valve with the delivery apparatus into the native valve. The alignment ring 1600 may be configured to allow mounting of the prosthetic valve on a delivery apparatus with a selected commissure of the prosthetic valve displaced circumferentially from a radiopaque marker on the delivery apparatus by a first predetermined amount, the first predetermined amount being results in the prosthetic valve being implanted with commissures in alignment 191 with the commissures of the native valve after deployment of the prosthetic valve with the delivery apparatus having the radiopaque marker aligned with the guide in its predetermined orientation (e.g., indicating that the marker is arranged directly posterior to image view). The alignment ring 1600 may be configured (e.g., structured) similar to or the same as the ring body 1038 of Figures 46 and 47. For example, the alignment ring 1600 may include one or more indicators (e.g., indicators or alignment markers) 1610a-c arranged on one or more surfaces of a body 1602 of the alignment ring 1600. As described above with reference to Figures 46 and 47, the indicators 1610a-c may be depressions (e.g., grooves) or engravings on the one or more surfaces, raised features extending radially outward from the one or more surfaces, and / or markings (e.g., printed, painted, or stamped lines) on the one or more surfaces. As shown in Figure 65, the alignment ring 1600 includes three indicators 1610a-c spaced apart about a circumference of the alignment ring 1600. However, in alternative embodiments, the alignment ring 1600 may include fewer than three indicators. 1610a-c, such as one or two. Indicators 1610a-c can 192 be configured to indicate a desired orientation for the commissures of the prosthetic valve when the prosthetic valve is mounted around an implant holding device (for example, such as the support body 1010 shown in Figures 45 and 48) when the alignment ring is attaches to the implant holding device (for example, as shown in Figure 48). As shown in Figure 65, a first indicator 1610a can be separated from a first lever (e.g., radial extension) 1604 by a first arc length 1606. In some embodiments, the alignment ring 1600 may include an additional mark or indicator indicating its intended use for the alignment of a prosthetic valve to be implanted in an implantation procedure using the three-cusp imaging view. For example, as shown in Figure 65, the alignment ring includes a first label 1608 (View A) that indicates the imaging view selected for the implantation procedure. In some embodiments, the selected imaging view (View A) may be the three-cusp imaging view described above. In alternative embodiments, the first label 1608 may be a color code, a symbol, a numerical code, or the like. Figure 66 shows another embodiment of an alignment ring 1700 that can be configured to align in a manner 193 rotating a prosthetic valve relative to a delivery apparatus for an implantation procedure by using a second imaging view, such as right / left cusp overlap imaging view (e.g., right cusp overlap view / left 1550 of Figure 63), to align and rotatably implant the prosthetic valve with the delivery apparatus in the native valve. The alignment ring 1700 may be configured to allow mounting of the prosthetic valve on a delivery apparatus with a selected commissure of the prosthetic valve displaced circumferentially from a radiopaque marker on the delivery apparatus by a second predetermined amount, the second predetermined amount being results in the prosthetic valve being implanted with commissures in alignment with the commissures of the native valve after deployment of the prosthetic valve with the delivery apparatus having the radiopaque marker aligned with the guide in its predetermined orientation (e.g., that indicates that the marker is arranged directly behind the image view). The second predetermined amount may be different from the first predetermined amount described above with reference to the alignment ring 1600. The alignment ring 1700 may be configured (e.g., structured) similar to or the same as the body 194 of the ring 1038 of Figures 46 and 47. For example, similar to the alignment ring 1600, the alignment ring 1700 may include one or more indicators 1710a-c arranged on one or more surfaces of a body 1702 of the ring 1702. alignment 1700. As shown in Figure 66, the alignment ring 1700 includes three indicators 1710a-c spaced apart about a circumference of the alignment ring 1700. However, in alternative embodiments, the alignment ring 1700 may include fewer than three indicators. 1710a-c, such as one or two. The indicators 1710a-c may be configured to indicate a desired orientation for the commissures of the prosthetic valve when the prosthetic valve is mounted around an implant holding device (e.g., such as the support body 1010 shown in Figures 45 and 48) when The alignment ring attaches to the implant holding device (e.g., as shown in Figure 48). As shown in Figure 66, a first indicator 1710a can be separated from a first lever (e.g., radial extension) 1704 by a second arc length 1706. In some embodiments, the alignment ring 1700 may include an additional mark or indicator indicating its intended use for the alignment of a prosthetic valve to be implanted in an implantation procedure using 195 view of three cusp images. For example, as shown in Figure 66, the alignment ring includes a first label 1708 (View B) that indicates the imaging view selected for the implantation procedure. In some embodiments, the selected imaging view (View B) may be the right / left cusp overlay view, as described above. In alternative embodiments, the first label 1708 may be a color code, a symbol, a numerical code, or the like. Figures 65 and 66 show two possible embodiments of the individual alignment rings that are configured for use with differently selected image views for a valve implantation procedure, as described herein. However, additional alignment rings configured similarly to those shown in Figures 65 and 66 but with a different orientation of indicators (commissure markers) are also possible for differently selected image views. Thus, in some embodiments, a user can select from a plurality of different alignment rings that are unique to a selected imaging view, for an implantation procedure. Figure 67 shows another embodiment of a ring of 196 alignment 1800. The alignment ring 1800 may be similar to the other alignment rings (or ring bodies) described herein, but includes multiple sets of indicators (e.g., alignment markers) for use in two or more implementation procedures that use differently selected image views. For example, the alignment ring 1800 may be configured for its intended use with two different fluoroscopic image views. In the example of Figure 67, the alignment ring 1800 includes a first set of indicators 1802 and a second set of indicators 1804 that move circumferentially relative to each other. In one embodiment, the first set of indicators 1802 may be used for an implantation procedure using the three-cusp imaging view and the second set of indicators 1804 may be used for a different implantation procedure using the right cusp overlap view. / left. In some embodiments, the first set of indicators 1802 may have a different color than the second set of indicators 1804. In this way, different color indicators may correspond to different image views. In other embodiments, the first set of indicators 1802 may have different marking (e.g., lines 197 versus dots) to the second set of indicators 1804. In still other embodiments, the first set of indicators 1802 can be arranged on a first side (or surface) of the alignment ring 1800 while the second set of indicators 1804 can be arranged on a second side (or surface), opposite of the alignment ring 1800. Figure 68 shows another embodiment of an alignment ring 1900. The alignment ring 1900 may be similar to the other alignment rings (or ring bodies) described herein, but includes one or more sets of indicators 1902, each set of indicators that includes a plurality of graduated indicators (or marks). For example, each set of indicators 1902 may include a first indicator (e.g., standard or base) 1904, a second indicator 1906 that is displaced circumferentially from the first indicator 1904 by a first amount (e.g., 10°), a third indicator 1908 that moves circumferentially from the first indicator 1904 by a second amount (e.g., 20°), and a fourth indicator 1910 that moves circumferentially from the first indicator 1904 by a third amount (e.g., 30°). In alternative embodiments, the indicator sets 1902 may include more or fewer graduated marks than those shown in Figure 68. 198 A graduated alignment ring having a plurality of graduated marks for one or more commissure locations, such as alignment ring 1900, may be useful for patients with atypical anatomy or for user-customized image views. For example, a user (e.g., physician) may identify from a preprocedural CT scan (or other imaging modality) that the patient has a native valve with commissures and / or coronary arteries in unusual locations (e.g. example, non-standard). Therefore, a more customizable alignment ring, such as the 1900 Graduated Alignment Ring, may allow the clinician to shift the commissures of the prosthetic valve from the more standard location. For example, the displacement of a native valve commissure from the expected location could be measured on CT before the procedure and the clinician could then ask a user to displace the prosthetic valve commissures by 20° from the standard in the annulus. alignment and the implant holding device (for example, by using the third indicators 1908 shown in Figure 68). Thus, methods, assemblies, and / or apparatus are provided for implanting a prosthetic heart valve into a native valve with the commissures of the prosthetic heart valve aligning circumferentially with the 199 commissures of the native valve. As a result, access to the coronary arteries may be increased. In some embodiments of the delivery apparatus and / or methods described herein, a portion of the distal end of the delivery apparatus may include a valve mounting portion that is configured to receive a prosthetic valve radially compressed thereon and a polymeric body disposed near the mounting portion of the valve. In some embodiments, the polymeric body may include a radiopaque marker that is configured to indicate a location of a commissure of the prosthetic valve after radially expanding the prosthetic valve through inflation of a balloon of the delivery apparatus. In some embodiments, the polymeric body may include a radiopaque marker that is configured to align with a guide extending through a center of the delivery apparatus in a predetermined orientation such that the prosthetic valve is implanted with commissures in alignment with the commissures of a native valve. In some embodiments, the methods, assemblies, and / or apparatus may additionally or alternatively include a method for radially arranging and compressing a prosthetic valve onto a valve mounting portion of a delivery apparatus such that a selected commissure of the valve prosthetic is in a position and orientation 200 predetermined relative to the radiopaque marker of the delivery apparatus. In some embodiments, the methods, assemblies, and / or apparatus may additionally or alternatively include a method of forming and / or bending the balloon of the delivery apparatus that results in a consistent amount of rotation of the prosthetic valve during deployment of the valve. prosthetic valve in the radially expanded state. As a result, after inflating the balloon and radially expanding the prosthetic valve, the selected commissure of the prosthetic valve can be aligned, in a circumferential direction, with the radiopaque marker of the delivery apparatus and / or a target commissure of the native valve. In some embodiments, the methods, assemblies, and / or apparatus may additionally or alternatively include a delivery apparatus that is configured to rotate the balloon of the delivery apparatus with the prosthetic valve crimped (e.g., radially compressed) without adversely affecting a capacity. flexion of the distal end portion of the delivery apparatus and / or inflation of the balloon. In some embodiments, the methods, assemblies, and / or apparatus may additionally or alternatively include the delivery apparatus with the radiopaque marker, wherein the radiopaque marker is visible under fluoroscopy and has a 201 asymmetric shape that allows a user to determine whether the marker is placed in a front or back portion of the fluoroscopic view (e.g., as seen by the user). In some embodiments, the methods, assemblies, and / or apparatus may additionally or alternatively include a method for rotating the distal end portion of the delivery apparatus, which includes the radiopaque marker and the radially compressed prosthetic valve, during an implantation procedure. , to rotatably align the marker with a target commissure of the native valve where the prosthetic valve is intended to be implanted, a guide extending through the delivery apparatus, and / or the predetermined location within a selected imaging view. In some embodiments, the method of turning may occur during a selected portion of the implantation procedure that reduces a possibility of clinical complications occurring. In some embodiments, the methods, assemblies, and / or apparatus may additionally or alternatively include a method for rotatably aligning the radiopaque marker of the delivery apparatus with a selected commissure of the native valve, using a selected fluoroscopic view obtained during the implantation procedure, and deploy the prosthetic valve within the native valve, with the delivery apparatus, so that 202 the selected commissure of the prosthetic valve is aligned circumferentially with the selected commissure of the native valve. Each of the above-described features of the methods, assemblies, and / or apparatus may be combined with any one or more of the other above-described features of the methods, assemblies, and / or apparatus. In this way, a prosthetic valve can be more easily deployed at an implantation site so that the commissures of the radially expanded prosthetic valve align with the commissures of the native valve, thereby preventing the placement of the commissures of the prosthetic valve becomes blocked and / or placed in front of the coronary arteries. As a result, blood flow to and access to the coronary arteries may be increased. In some embodiments, a balloon coating may be configured to enclose (e.g., encapsulate) a portion of the distal end of a delivery apparatus (e.g., a portion of the distal end 309 of the delivery apparatus 300 shown in Figures 10 and 40 -42) that includes an inflatable balloon mounted (and folded) on it during shipping and / or storage before use and / or during a deaeration process. For example, before crimping a prosthetic valve in the balloon of a delivery apparatus the user performs 203 typically a cyclic deaeration process that involves pushing the inflation fluid into the balloon and then withdrawing the fluid from the balloon, such as with a syringe fluidly connected to the handle of the delivery apparatus. The deaeration process may be most effective when the balloon is allowed to inflate at least partially. However, inflation of the balloon outside of a balloon coating may result in folding of the balloon, which may inhibit or prevent the balloon from returning to its folded state (e.g., as shown in Figure 37) when remove the inflation fluid from the balloon. A balloon overlay may be configured to prevent complete unfolding of the balloon and / or assist the balloon in returning to its fully folded state after the inflation fluid is removed from the balloon. Traditional balloon shells may comprise two shell portions or halves that are configured to arrange and fit together around the distal end portion of the implantation apparatus, which includes the balloon (e.g., the distal end portion 309 of the apparatus). implantation plate 300, with balloon 318 mounted thereon, as shown in Figures 9-11 and 40). In some embodiments, a removable sleeve may slide over and around the assembled balloon shell to contain (and engage) the two portions of the balloon shell. 204 balloon coating joints. When a user is ready to assemble or crimp a prosthetic valve onto the delivery apparatus, around the balloon (e.g., as shown in Figure 41), a user can grasp the delivery apparatus and pull to remove the cuff from the apparatus. of supply. However, when the delivery apparatus includes a positioning device coupled to the distal end portion of the delivery apparatus (e.g., positioning device 1100 coupled to the distal end portion 309 of the delivery apparatus 300, as shown in Figures 54 and 55 or the positioning device 1072 coupled to a portion of the distal end of a delivery apparatus, as shown in Figure 49), a user can grasp the positioning device during removal of the sleeve from the balloon coating . For example, a user can grasp the positioning device with one hand and then slide the sleeve out of the balloon shell and off a distal end of the delivery apparatus with the other hand. This may result in movement of the positioning device relative to the delivery apparatus (and the radiopaque marker on the distal end portion of the delivery apparatus, as described herein). As a result, the prosthetic valve 205 may subsequently be mounted on the balloon in an incorrect circumferential orientation relative to the marker, which may result in misalignment of the commissures of the prosthetic valve with the commissures or the native valve, at the site of implantation (e.g. during an implantation procedure, as explained above with reference to Figure 57). To address such problems, a balloon cover for a balloon mounted in and around a distal end portion of a delivery apparatus may comprise first and second cover members, each having a first, narrower portion configured to receiving (and enclosing therein) the distal end portion of the delivery apparatus that includes the balloon and a second, wider portion configured to receive (and at least partially enclosing therein) the positioning device. In this way, the second portion can surround the positioning device and prevent a user from directly contacting or grasping the positioning device, thereby preventing any unwanted movement (e.g., rotation) of the positioning device with relation to the delivery apparatus during removal of the balloon coating from the delivery apparatus. Figures 69-76B and Figures 108-114 show 206 embodiments of a balloon cover that is configured to cover a portion of the distal end of a delivery apparatus (e.g., distal end portion 309 of the delivery apparatus 300, as shown in Figures 69, 72-76B, and 108-114) including a reliable balloon (e.g., balloon 318) mounted thereon and a positioning device coupled to the distal end portion of the delivery apparatus proximal to a valve mounting portion of the delivery apparatus (e.g., positioning device 1100, as shown in Figures 69, 72-76B, and 108-114). Figures 69-75C show an illustrative embodiment of such a balloon cover (or balloon cover assembly) 2000 comprising a first portion of the cover 2001 that is configured to cover at least a portion of the distal end of the delivery apparatus that includes the balloon and a second portion of the liner 2003 that is configured to cover the positioning device (the liner portions 2001 and 2003 shown in Figures 72 and 73). The balloon skin 2000 may comprise a first shell member 2002 and a second shell member 2004 that are configured to couple together and releasably couple together. For example, the first shell member 2002 and the second shell member 2004 may comprise two 207 halves of an outer shell 2006 of and / or forming the covering of the balloon 2000 (Figure 69). The outer shell 2006 and balloon liner 2000 are shown in a disassembled configuration in the exploded view of Figure 69 and in an assembled configuration in the various views of Figures 72-75C. Figure 70 shows the first cover member 2002, disassembled from the rest of the balloon skin 2000. However, since in some embodiments the first cover member 2002 and the second cover member 2004 can be configured in the same way (e.g., formed identically), the first shell member 2002 shown in Figure 70 may alternatively be the second shell member 2004. Additionally, Figures 71A-71C show detail views of a mating interface 2008. (Figure 71C) between and related to features or members of the coupling interface (Figures 71A-71C) of the first shell member 2002 and the second shell member 2004. Each of the first cover member 2002 and the second cover member 2004 include a first portion (e.g., first cover portion) 2010 and a second portion (e.g., second cover portion) 2012. In some modalities, the first portion 2010 and the second portion 2012 of one of the first member of 208 the cover 2002 and the second cover member 2004 may be continuous with each other (e.g., formed as a single piece). In some embodiments, the second portion 2012 may have a second width 2018 that is greater than a first width 2016 of the first portion 2010 (Figure 70), the widths defined in a radial direction relative to a central longitudinal axis 2014 of the coating of the balloon 2000 (which may be coaxial with a central longitudinal axis of the delivery apparatus when assembled and fitted around the delivery apparatus). In some embodiments, the first width 2016 and the second width 2018 may be diameters. When the first shell member 2002 and the second shell member 2004 are assembled together (e.g., in coupling), the first portions 2010 of the first shell member 2002 and the second shell member 2004 may form the first portion of the coating 2001 and defining an elongated cavity 2020 (which, in some embodiments may be referred to as a lumen). The cavity 2020 may be configured to receive a distal end portion of a delivery apparatus and at least a portion of a balloon (e.g., a majority portion in some embodiments) mounted on the distal end portion of the delivery apparatus (e.g. , balloon 318 of the distal end portion 309, as shown in the 209 Figures 69 and 72-75C). For example, the first portion 2010 of the first shell member 2002 (and similarly, the second shell member 2004) comprises an outer surface 2022 (Figures 69 and 70) and an inner surface 2024 (Figure 70). The inner surface 2024 may be a mating surface that is configured to mate with or engage with (e.g., have face-to-face contact with) a respective inner surface of the first portion 2010 of the other cover member (e.g., second ) that forms the covering of the balloon 2000. In some embodiments, the inner surface 2024 may be a planar surface. The first portion 2010 may further include a depression 2026 that depresses into the inner surface 2024 (towards the outer surface 2022). Together, the depressions 2026 of the first shell member 2002 and the second shell member 2004 may form the cavity 2020. Therefore, each depression 2026 of each of the first shell member 2002 and the second shell member 2004 may define a portion of the middle cavity 2021 of cavity 2020 (Figure 70). Each depression 2026 may be formed to receive a portion of the distal end portion 309 of the delivery apparatus. For example, each depression 2026 may include a distal section 2028, a proximal section 2030, and a 210 intermediate section 2032, the intermediate section 2032 arranged between the distal section 2028 and the proximal section 2030 (Figure 70). In some embodiments, the distal section 2028 may be formed (e.g., configured) to receive the balloon (e.g., balloon 318) and the portion of the delivery apparatus that covers the balloon. For example, in the embodiment shown in Figures 69-75C, the distal section 2028 may be formed to receive a portion of the nose cone 322 and the distal end portion 332 of the balloon 318 that covers the distal rim 326 of the delivery apparatus 300. In some embodiments, the intermediate section 2032 may be formed (e.g., configured) to receive the intermediate portion 335 of the balloon and the portion of the delivery apparatus 300 that covers the intermediate portion 335 (e.g., the valve mounting portion 324). ). In some embodiments, the proximal section 2030 may be formed (e.g., configured) to receive at least a distal portion of the proximal end portion 333 of the balloon 318. In some embodiments, a more proximal portion of the proximal end portion 333 of the Balloon 318 may extend into the second portion 2012 of the first shell member 2002 or the second shell member 2004 (Figures 70 and 72). In other embodiments, the proximal section 2030 may be formed to receive an entire portion 211 of the proximal end 333 of the globe 318. In this way, a shape or contour of the depression 2026 may vary along a first length 2034 of the first portion 2010, the first length 2034 extending in an axial direction relative to the central longitudinal axis 2014 (Figure 70). . For example, as shown in Figure 70, the intermediate section 2032 is narrower than each of the distal section 2028 and the proximal section 2030. In some embodiments, a width of the intermediate section 2032 is constant along a majority of an intermediate section length 2032. In other embodiments, each depression 2026 may include the distal section 2028 and a proximal section that may resemble the intermediate section 2032 and extend from the distal section 2028 to the second portion 2012. In such embodiments, the proximal section may be configured to receive the intermediate portion 335 of the balloon and the portion of the delivery apparatus 300 that covers the intermediate portion 335 (e.g., the valve mounting portion 324). In some embodiments, the proximal section may be further configured to receive the proximal end portion 333 of the balloon 318 which may not have a wider diameter portion than the intermediate portion 335 when disposed within the liner of the balloon 2000. Such illustrative embodiment is shown in Figures 108-114, as further described 212 below. In some embodiments, the first length 2034 of the first portion 2010 may be longer than a second length 2036 of the second portion 2012. In other embodiments, the second length 2036 of the second portion 2012 may be the same or longer than the first length 2034 of the first portion 2010. In some embodiments, the second length 2036 of the second portion 2012 may be selected based on a length and / or size of the positioning device (e.g., positioning device 1100) that is contained within the second portions 2012 of the first member of the cover 2002 and the second member of the cover 2004 when coupled together in coupling. For example, in some embodiments, the second length 2036 may be the same or longer than a length of the positioning device 1100. In some embodiments, the second length 2036 may be shorter than a length of the positioning device 1100, but long enough to sufficiently cover the positioning device (e.g., a majority portion or wider or larger diameter portions of the positioning device) such that a user is blocked or deterred from grasping the positioning device 1100. 213 When the first shell member 2002 and the second shell member 2004 are assembled together (e.g., coupled together in mating), the second portions 2012 of the first shell member 2002 and the second shell member 2004 can form the second portion of the coating 2003 and define a cavity 2038 (Figures 69 and 72-75A). The cavity 2038 may be configured to receive a positioning device (e.g., positioning device 1100, as shown in Figures 69 and 72-75C) mounted on the distal end portion 309 of the delivery apparatus 300, proximal to a portion valve mounting 324 of the distal end portion 309. The inner surfaces of the walls of the second portion 2012 may define a portion of the middle cavity 2040 of the cavity 2038 (Figure 70). For example, as shown in Figure 70, the second portion 2012 of the first cover member 2002 (and the second cover member 2004) may be defined by a first wall 2050, a second wall 2052, a third wall 2054, and a fourth wall 2056. The first wall 2050 may be relatively flat and the central longitudinal axis 2014 may be normal to the first wall 2050. The second wall 2052 and the third wall 2054 may be curved (as shown in Figures 69- 75C). The fourth wall 2056 may be relatively flat and 214 arranged perpendicular to the first wall 2050. In some embodiments, the fourth wall 2056 may define an opening (which may be further referred to herein as a window) 2046 and extend between the second wall 2052 and the third wall 2054 (e.g. , in a circumferential direction or in a direction that is perpendicular to the central longitudinal axis 2014). In other embodiments, as further explained below with reference to Figures 76A and 76B, the second portion 2012 may not include the fourth wall 2056 (and the opening 2046) and instead the second wall 2052 and the third wall 2054 they can be continuous with each other (e.g., forming a continuously curved wall, forming a half-complete cylinder). Each of the walls of the second portion 2012 may include an internal surface and an external surface. For example, the first wall 2050 may have a first internal surface 2042, the second wall 2052 may have a second internal surface 2044, the third wall 2054 may have a third internal surface 2043, and the fourth wall 2056 may have a fourth internal surface 2048 (Figure 70) . The first inner surface 2042, the second inner surface 2044, the third inner surface 2043, and the fourth inner surface 2048 may define the portion of the middle cavity 2040. 215 As shown in Figures 69 and 70, in some embodiments, the depression 2026 may extend to the first internal surface 2042. In this way, the depression 2026 may be continuous from the first internal surface 2042 to a distal end of the first portion 2010. In some embodiments, the second inner surface 2044 and the third inner surface 2043 are each curved and, together, form a half-cylinder shape of the second portion 2012. In some embodiments, the second inner surface 2044 and the first inner surface 2042 They are separated from each other by the opening 2046 and connected together by the fourth internal surface 2048, at a proximal end of the second portion 2012. The second portion 2012 of the first shell member 2002 (and similarly, the second shell member 2004) may further include a mating surface 2058 that is configured to engage a corresponding mating surface of the second shell member. 2004 (as shown in Figure 71C). The mating surface 2058 may be formed along the edges of the first wall 2050, the second wall 2052, and the third wall 2054. In some embodiments, the mating surface 2058 of the second portion 2012 may be continuous with (and / or in the same plane) as the internal surface 2024 of the 216 first portion 2010. In this way, the inner surface 2024 and the mating surface 2058 can form a complete mating surface of the first shell member 2002 or the second shell member 2004. In some embodiments, the coupling surface 2058 may be flat or relatively flat and include a first coupling element, which in some embodiments may be configured as a protrusion (or tongue) 2060 that extends along a first portion of the surface. coupling element 2058 (e.g., on a first side of the coupling surface 2058, relative to the central longitudinal axis 2014) and a second coupling element, which in some embodiments may be configured as a groove (or depression) 2062 that extends along a second portion of the mating surface 2058 (e.g., on a second side of the mating surface 2058 that is opposite the first side, relative to the central longitudinal axis 2014). A detailed view of the first portion of the mating surface 2058 that includes the protrusion 2060 is shown in Figure 71A and a detailed view of the second portion of the mating surface 2058 that includes the groove 2062 is shown in Figure 71B. The protrusion extends outward from the mating surface 2058 and the groove 2062 is depressed into the mating surface 2058. 217 Figure 71C is a detailed view of the coupling interface 2008 between the protrusion 2060 of the first member of the cover 2002 (for example, in the first portion of the mating surface 2058 of the first cover member 2002) and the groove 2062 of the second cover member 2004 (for example, in the second portion of the surface ficd_e coupling 2058 of the second member of the cover 2004). As shown in Figure 71C, in some embodiments, the respective mating surfaces 2058 of the respective second portions 2012 of the first cover member 2002 and the second cover member 2004 can be positioned with each other (e.g., in face-to-face contact). to face) and the protrusion 2060 of the first cover member 2002 may extend (and interact or engage with) the groove 2062 of the second cover member 2004. The reverse of this engagement may occur on the second portions of the mating surfaces 2058 of the first cover member 2002 and the second cover member 2004 (for example, on an opposite side of the balloon skin 2000, the protrusion 2060 of the second cover member 2004 may extend inward and interact or engage with the slot 2062 of the first member of deck 2002. In other embodiments, the coupling interface 2008 between the first shell member 2002 and the second 218 cover member 2004 may be configured differently with different latch or interface engagement features (e.g., such as other or complementary lock and key features). In some embodiments, the coupling interface 2008 between the first cover member 2002 and the second cover member 2004 may have different protrusion and depressed engagement characteristics, such as a differently shaped protrusion (e.g., triangular in section). transverse or a series of separate protrusions) and a groove(s) or depression(s) formed accordingly. The configuration of the docking interface 2008, as described above, may prevent the first cover member 2002 and the second cover member 2004 from sliding relative to each other when the assembled balloon skin 2000 is grasped or handled by a user. . Once assembled into mating (as shown in Figures 72-75C), the first shell member 2002 and the second shell member 2004 may be contained or coupled together (e.g., so that they cannot be separated from each other). through a coupling element. In some embodiments, as shown in Figures 69, 72, 73, and 75A, the coupling element may be configured as a sleeve 2064. In some embodiments, the sleeve 219 2064 may be tubular and configured to slide over and around the first portions 2010 coupled together of the first cover member 2002 and the second cover member 2004. For example, the sleeve 2064 may be configured to contain the first cover member 2002 and the second member of the deck 2004 in coupling with each other. As a result, the balloon liner 2000 can be contained attached (and mounted) in and around the distal end portion 309 of the delivery apparatus. As introduced above and shown in Figures 72 and 73, when assembled together, the first portions 2010 of the first cover member 2002 and the second cover member 2004 may cover and enclose therein a portion of the portion of the distal end 309 of the delivery apparatus and the balloon 318. In some embodiments, the portion of the delivery apparatus covered by the first portions 2010 of the coating of the balloon 2000 may include a portion of the nose cone 322, the distal rim 326, the valve mounting portion 324, and an inner shaft portion 308 on which the proximal end portion 333 of the balloon 318 is disposed around, and the portions of the balloon 318 covering these portions of the delivery apparatus (Figure 72) . Additionally, as shown in Figures 72 and 73, when assembled together, the second portions 2012 of the 220 first cover member 2002 and second cover member 2004 may cover and enclose therein a positioning device (e.g., positioning device 1100) mounted on the distal end portion 309 of the delivery apparatus, proximal to the valve mounting portion 324 of the distal end portion 309 of the delivery apparatus. In some embodiments, the second portions 2012 of the first cover member 2002 and the second cover member 2004 may cover and enclose an entire positioning device 1100. In other embodiments, the second portions 2012 of the first cover member 2002 and the second cover member 2004 may cover and enclose a majority of the positioning device 1100 (e.g., all but a more proximal portion, as shown in Figures 72 and 72). When assembled together, the second portions 2012 of the first shell member 2002 and the second shell member 2004 may form a closed distal end 2066 (Figures 72, 73, and 75A) and an open proximal end 2068 (Figures 72- 75C). For example, the closed distal end 2066 may be formed by outer surfaces 2070 of the first walls 2050 of the first cover member 2002 and the second cover member 2004. In other embodiments, the distal end 2066 may 221 open at least partially with one or more openings or windows in the first walls 2050 of the first cover member 2002 and / or the second cover member 2004. Additionally, in some embodiments (as shown in Figures 74-75C), the open proximal end 2068 may be formed by edge portions 2072 of the second wall 2052 and the third wall 2054 of each of the first cover member 2002 and the second member of the 2004 deck. In other embodiments, the proximal end 2068 may be at least partially closed. For example, in such embodiments, edge portions 2072 may extend radially inward to form partial walls (e.g., not completely enclosed). The first portions 2010 of the first cover member 2002 and the second cover member 2004 extend distally, in the axial direction, from the closed distal end 2066. The outer wall surfaces of the second portions 2012 of the first cover member 2002 and the second cover member 2004 may form the second cover portion 2003 of the balloon cover 2000 and may provide a surface for a user to grip. and / or is contained when the sleeve 2064 slides from the first portions 2010 (so that 222 the coating of the balloon 2000 can be removed from the delivery apparatus). When the second portions 2012 of the first shell member 2002 and the second shell member 2004 are assembled to form the second shell portion 2003, a cylinder-shaped enclosure (e.g., cylinder) may be formed. The internal dimensions of the cylinder-shaped enclosure may define the cavity 2038. For example, the second portion of the liner 2003 may have an internal diameter 2074 and an internal height 2076 (Figures 74 and 75B). The internal height 2076 may be defined between the fourth internal surface 2048 of the fourth wall 2056 of the first shell member 2002 and the fourth internal surface 2048 of the fourth wall 2056 of the second shell member 2004 (Figure 74). The inner diameter 2074 may be defined between oppositely arranged curved walls (e.g., second walls 2052, as shown in Figure 74) of the first shell member 2002 and the second shell member 2004. As shown in Figures 75B and 75C, the inner diameter 2074 and the inner height 2076 can be selected based on a larger dimension of the positioning device that is contained within the cavity 2038. For example, the inner diameter 2074 and the internal height 2076 can be selected so that the flange portion 223 1112 of the positioning device 1100 fits within the cavity 2038, without touching (e.g., by separating away from) the second internal surfaces 2044 and the third internal surfaces 2043 of the first cover member 2002 and the second cover member 2002. the cover 2004. For example, the inner diameter 2074 may be larger than an outer diameter of the flange portion 1112. In some embodiments, the internal height 2076 may be the same or slightly smaller than the outer diameter of the flange portion 1112. For example, in some embodiments, as shown in Figure 75C, one or more portions of the flange portion flange 1112 of the positioning device 1100 (e.g., an extension portion 1114) may extend toward one of the openings 2046 (e.g., between the fourth inner surface 2048 and an outer surface of the fourth wall 2056). As such, when a user grasps the outside of the second portion of the liner 2003 (e.g., to remove sleeve 2064), any movement of the balloon liner 2000 will not result in movement of the positioning device 1100 relative to the apparatus. supply, since the coating of the balloon 2000 does not directly contact the positioning device 1100. For example, if it is rotated 224 the coating of the balloon 2000, this rotation will not result in the rotation of the positioning device 1100, thereby maintaining the positioning device in a specified and intended circumferential position relative to the delivery apparatus. This may allow a prosthetic valve to be mounted on the valve mounting portion of the delivery apparatus in a predetermined circumferential orientation relative to a radiopaque marker on the delivery apparatus, as discussed herein (e.g., as discussed above with reference to Figure 57). In some embodiments, as shown in Figures 74-75C, the internal height 2076 may be smaller than the internal diameter 2074. Accordingly, the second portion of the liner 2003 may have an external height 2078 that is smaller than a diameter outer 2080 (Figure 75B). The reduced internal height 2076 and external height 2078, compared to the corresponding diameters, of the second portion of the liner 2003 can reduce an overall packaging space of the balloon liner 2000. This can reduce the material costs of the balloon liner itself and the packaging materials used to contain the balloon coating. Therefore, the inner diameter 2074 and the inner height 2076 can be selected to be as small as possible to reduce 225 the packaging space, while still being large enough to prevent engagement with the positioning device (Figure 76C). In some embodiments, the configuration of the openings 2046 in the fourth walls 2056 of the first cover member 2002 and the second cover member 2004 may result in reduced internal height 2076 and external height 2078. In some embodiments, the openings 2046 may further allow a user to view the positioning device 1100 and the distal end portion 309 of the delivery apparatus 300, which may allow for easier assembly of the balloon coating 2000 around the delivery apparatus. . In other embodiments, the second portion of the cover 2003 may be cylindrical and the first cover member 2002 and the second cover member 2004 may have walls that completely enclose the positioning device therein, without any opening. For example, Figures 7 6A and 7 6B show another illustrative embodiment of a balloon cover 2100 comprising a first cover member 2102 and a second cover member 2104 that are configured to engage each other and releasably engage each other. Yeah. The first member of deck 2102 and the second 226 cover member 2104 may be configured similarly to the first cover member 2002 and the second cover member 2004 of the balloon skin 2000 (Figures 69-75C), except that the first cover member 2102 and the second Cover member 2104 does not include an opening 2046 and an inner diameter 2106 and the outer diameter 2108 of a second liner portion 2110 (similar to the second liner portion 2003) are constant around a circumference of the second liner portion 2110. (Figure 7 6B). As such, the second portion of the skin 2110 does not have a reduced height (compared to the balloon skin 2000). Therefore, the 2100 balloon liner (Figures 76A and 76B) can increase the packaging space compared to the 2000 balloon liner (Figures 69-75C). Figures 108-114 show another embodiment of a balloon coating 2600 that is configured to cover a portion of a distal end portion of a delivery apparatus (e.g., distal end portion 309 of delivery apparatus 300) that includes a inflatable balloon (e.g., balloon 318) mounted thereon and a positioning device coupled to the distal end portion of the delivery apparatus, proximal to a valve mounting portion of the delivery apparatus 227 (e.g., positioning device 1100). The balloon liner 2600 may be similar to the balloon liner 2000 of Figures 69-75C, except that it is configured to receive a portion of the positioning device and prevent rotation of the positioning device and the balloon liner 2600 relative to each other. For example, independent rotation between the positioning device and the balloon liner 2600 can result in twisting of the balloon, thereby causing unpredictable rotation of the prosthetic heart valve during deployment of the valve at the delivery site. implantation (and therefore uncertainty about the positioning of the commissures of the prosthetic valve in relation to the commissures of the native valve). The balloon liner 2600 comprises a first portion of the liner 2601 that is configured to cover at least a portion of the distal end portion of the delivery apparatus that includes the balloon and a second portion of the liner 2603 that is configured to cover the delivery device. positioning. The balloon liner 2600 may comprise a first shell member 2602 and a second shell member 2604 that are configured to couple together and releasably couple together (Figures 110 and 113). For example, the first cover member 2602 and the second cover member 2604 can 228 comprise two halves of an outer shell 2606 of and / or forming the covering of the balloon 2600 (Figure 110). The outer shell 2606 and balloon liner 2600 are shown in a disassembled configuration in the exploded view of Figure 110 and in an assembled configuration in the various views of Figures 108, 109, 111, and 113. In addition, Figure 113 shows a cross-sectional view of the balloon liner 2600 while Figure 114 shows one of the cover members (e.g., the first cover member 2602) disposed around the delivery apparatus. In some embodiments, the first cover member 2602 and the second cover member 2604 may have a similar or the same mating interface 2008 as described above with reference to Figures 71A-71C. Each of the first cover member 2 602 and the second cover member 2604 include a first portion (e.g., first cover portion) 2610 and a second portion (e.g., second cover portion) 2612. In some embodiments, the first portion 2610 and the second portion 2612 of one of the first cover member 2602 and the second cover member 2604 may be continuous with each other (e.g., formed as a single piece). Similar to the balloon liner 2000, the second portion 2612 of the balloon liner 2600 can 229 have a greater width than the first portion 2610. When the first cover member 2602 and the second cover member 2604 are assembled together (e.g., in mating), the first portions 2610 of the first cover member 2602 and the second cover member 2604 may form the first portion of the coating 2601 and define an elongated cavity 2620 (Figures 110 and 113). The cavity 2620 may be configured to receive a distal end portion of a delivery apparatus and at least a portion of a balloon (e.g., a majority portion in some embodiments) mounted on the distal end portion of the delivery apparatus (e.g. , balloon 318 of the distal end portion 309, as shown in Figures 110, 113, and 114). For example, the first portion 2610 of the first cover member 2602 (and similarly, the second cover member 2604) comprises an outer surface (oriented radially outward) 2622 (Figures 110, 112, and 113) and a internal surface (oriented radially inward) 2624 (Figures 110 and 114) . The inner surface 2624 may be a mating surface that is configured to mate with or engage with (e.g., have face-to-face contact with) a respective inner surface of the first portion 2610 of the other cover member (e.g., second ) that forms the covering of the balloon 230 2600. In some embodiments, the inner surface 2624 may be a planar surface. In some embodiments, the first portion 2610 of one of the cover members (the second cover member 2604, as shown in Figures 110 and 112) may include an opening or window 2660 disposed across the outer surface 2622. and the inner surface 2624 and positioned so that the marker 600 on the distal flange (or another marker on the distal end portion of the delivery apparatus) can be viewed by a user when the balloon liner is attached to the delivery apparatus, as was described in the present description. The first portion 2610 may further include a depression 2626 that depresses into the inner surface 2624 (toward the outer surface 2622, Figures 110 and 114). Together, the depressions 2626 of the first cover member 2602 and the second cover member 2604 may form the cavity 2620. Each depression 2626 may be formed to receive a portion of the distal end portion 309 of the delivery apparatus. For example, each depression 2626 may include a distal section 2628 and a proximal section 2630 (Figure 110). In some embodiments, the distal section 2628 may be formed (e.g., configured) to receive the balloon (e.g., balloon 318) and the portion of the apparatus of 231 supply covering the globe. For example, in the embodiment shown in Figures 108-114, the distal section 2628 may be formed to receive a portion of the nose cone 322 and the distal end portion 332 of the balloon 318 covering the distal rim 326 of the delivery apparatus. 300 (Figures 110, 113, and 114). In some embodiments, the proximal section 2630 may be formed (e.g., configured) to receive the intermediate portion 335 of the balloon and the portion of the delivery apparatus 300 that covers the intermediate portion 335 (e.g., the valve mounting portion 324). ). In some embodiments, the proximal section 2630 may further be formed to receive at least a distal portion of the proximal end portion 333 of the balloon 318, but in the embodiment shown in Figures 108-114, the proximal end portion 333 of the balloon 318 may have the same profile or diameter as the intermediate portion 335. Therefore, the proximal section 2630 may have a constant or relatively constant width along its length (or a majority of its length), from the distal section 2628 to the second portion 2612 of the cover member. In other embodiments, each depression 2626 may be formed similar to the depression 2026 of the skin of the balloon 2000 shown in Figures 69-75C. In this way, a shape or outline of the depression 232 2626 may vary along a length of the first portion 2610. For example, as shown in Figures 110, 113, and 114, the proximal section 2630 is narrower than the distal section 2628. In some embodiments, the length of the first portion 2610 may be longer than a length of the second portion 2612, as described above with reference to Figures 69-75C. The second portion 2012 of each of the first cover member 2602 and the second cover member 2604 may be configured (sized and formed) based on a length and / or size of the positioning device (e.g., positioning device 1100 ) to be contained within the second portions 2612 of the first cover member 2 602 and the second cover member 2604 when engaged together in engagement. When the first cover member 2602 and the second cover member 2604 are assembled together (for example, coupled together in mating), the second portions 2612 of the first cover member 2602 and the second cover member 2604 can form the second portion of the coating 2603 and define a cavity 2638 (Figures 108 and 111-114). The cavity 2638 may be configured to receive a positioning device (e.g., positioning device 1100, as shown in the 233 Figures 108-114) mounted on the distal end portion 309 of the delivery apparatus 300, proximal to a valve mounting portion 324 of the distal end portion 309. In some embodiments, the overall dimensions of the cavity 2638, apart of the one or more cavities 2652 further described below, may be similar to the cavity 2038 of the balloon liner 2000, as described above. Similar to the liner of the balloon 2000 (Figures 69-75C), the inner surfaces of the walls of the second portion 2612 may define a middle cavity portion of the cavity 2638. In some embodiments, the second portion 2612 of the second member of The cover 2604 may be configured the same or similar to the second portion 2012 of the first and second cover members 2002 and 2004 of the balloon skin 2000 (see description of Figures 69-75C above). However, the second portion 2612 of the first cover member 2602 may have a first wall 2650 (the wall that connects to the first portion 2610) that is formed (e.g., keyed) to receive a portion of the positioning device. 1100. For example, the first wall 2650 of the second portion 2612 of the first cover member 2602 may be formed to form one or more cavities 2652 that are formed to receive and contain therein a portion of the flange portion 1112 of the 234 positioning device 1100 (Figures 110, 113, and 114). In some embodiments, the second portion 2612 of the first cover member 2602 may comprise one or more projecting wall portions 2654 that are part of or extend from the first wall 2650 to protrude into the cavity 2638 and form the one or more cavities 2652 (Figures 108, 110, 113, and 114). By configuring the first wall 2650 of the second portion 2612 of the first cover member 2602 to have the one or more cavities 2652, when the balloon liner 2600 is coupled to the delivery apparatus and around the positioning device 1100, it is avoided that the positioning device 1100 and the balloon cover 2600 rotate relative to each other. As a result, twisting of the balloon 318 can be avoided. In some embodiments, one of the cover portions of any of the other balloon skins described herein (e.g., with reference to Figures 69-86) may have a second portion comprising one or more cavities 2652 that They are formed to receive and contain therein a portion of the flange portion 1112 of the positioning device 1100, as described above with reference to Figures 108114. Returning to Figures 108-114, the remaining walls 235 of the second portion 2612 of the first cover member 2602 may be similar to the walls of the second cover member 2604. As described above with reference to the balloon liner 2000, the second portions 2612 of the balloon liner 2600 may define openings 2646. Once assembled into mating (as shown in Figures 108, 109, and 111-113), the first cover member 2602 and the second cover member 2604 can be contained or coupled together (for example, so that they do not can be separated from each other) through a coupling element. In some embodiments, the coupling element may be configured as a sleeve 2664. The sleeve 2664 may be configured the same or similar to the sleeve 2064 of the balloon liner 2000. As previously introduced, when assembled together, the first portions 2610 of the first cover member 2602 and the second cover member 2604 may cover and enclose therein a portion of the distal end portion 309 of the delivery apparatus and the balloon 318 (Figures 108, 109, and 111-114). In some embodiments, the portion of the delivery apparatus covered by the first portions 2610 of the balloon coating 2600 may include a portion of the nose cone 322, the distal rim 326, the valve mounting portion 324, and a portion of the 236 internal shaft 308, and the portions of the balloon 318 that cover these portions of the delivery apparatus (Figures 113 and 114). Similar to as described above with reference to Figures 69-75C, the outer wall surfaces of the second portions 2612 of the first cover member 2602 and the second cover member 2604 may form the second cover portion 2603 of the coating of the balloon 2600 and may provide a surface for a user to grasp and / or restrain when sliding the sleeve 2664 out of the first portions 2610 (so that the coating of the balloon 2600 can be removed from the delivery apparatus), without grasping the positioning device 1100. As introduced above with reference to Figures 38-41, the distal end portion 309 of the delivery apparatus 300 may include a distal tip portion 900 mounted on or disposed on the distal end of the outer shaft 304. In some embodiments, then By mounting the prosthetic valve in a radially compressed state about the valve mounting portion 324 of the delivery apparatus 300, the outer shaft 304 and the intermediate shaft (e.g., balloon shaft) 306 can move axially relative to each other so that the distal tip portion 900 is disposed over the proximal end portion 333 of the 237 balloon 318. As a result, the distal tip portion 900 can act as a proximal flange on a proximal side of the valve mounting portion 324 and resist movement of the radially compressed prosthetic valve, proximally in the axial direction, during advancing the distal end portion of the delivery apparatus to the target implantation site. As described above, prior to crimping the prosthetic valve around the valve mounting portion 324, the balloon 318 may be subjected to a cyclic deaeration process such that inflation fluid is introduced into the balloon and then removed from the balloon. balloon. The process of introducing the inflation fluid into the balloon 318 and then removing the inflation fluid can be repeated one or more times as necessary. During the deaeration process, the distal tip portion 900 is typically positioned proximal to the balloon 318 (e.g., away from and away from the proximal end portion 333 of the balloon 318) to facilitate the flow of inflation fluid into the portion. of the proximal end 333 of the balloon 318. In some embodiments, the deaeration process can be carried out while the balloon 318 is contained within a balloon coating. After the deaeration process, the balloon coating can be removed from the balloon and the outer shaft 304 can be moved axially with 238 relative to the intermediate axis 306 (and the internal axis 308) to a more distal position that extends over the proximal end portion 333 of the balloon 318 (as shown in Figure 41). When the distal tip portion 900 moves distally over the proximal end portion 333, residual fluid in the proximal end portion 333 of the balloon from the deaeration process may be pushed distally into the intermediate portion 335 and the distal end portion 332. of balloon 318. As previously introduced, to accommodate this residual fluid without increasing a crimp profile of the prosthetic valve in the delivery apparatus, a radial depression 334 may initially be formed in the distal end portion 332 of the balloon 318 (e.g., before moving the distal tip portion 900 on the proximal end portion 333 of the balloon 328, Figure 40). When the residual inflation fluid in the proximal end portion 333 of the balloon 318 is squeezed or pushed into the distal end portion 332 of the balloon 318 by advancing the distal tip portion 900, the displaced residual fluid may dilate the portion of the distal end 332 of balloon 318 from the radially depressed state shown in Figure 40 to the expanded state 924 shown in Figure 41 (and shown with dashed lines in Figure 40). As a result, unwanted inflation of the intermediate portion 324 can be avoided, which 239 can thus expand a crimp profile of the prosthetic valve. Various techniques and mechanisms can be used to achieve the balloon shape shown in Figure 40, including a balloon coating that has an internal cavity that is formed to produce the desired balloon shape (e.g., radial depression 334). Figures 77-83B show an illustrative embodiment of a balloon liner 2200 that is configured to receive (and cover) a portion of a distal end portion of a delivery apparatus (e.g., distal end portion 309 of the delivery apparatus 300, as shown in Figure 77) including an inflatable balloon (e.g., balloon 318) mounted thereon. In some embodiments, the balloon liner 2200 is configured to additionally receive a positioning device coupled to the distal end portion of the delivery apparatus proximal to a valve mounting portion of the delivery apparatus (e.g., positioning device 1100, as shown in Figures 53-55 and 77). More specifically, the balloon liner 2200 is configured to receive and create a final, specified shape of the balloon 318 (e.g., such as the shape shown in Figure 40, which includes the radial depression 334). For example, Figure 77 is an exploded view of the liner of the 240 balloon 2200 configured to assemble around the distal end portion 309 of the delivery apparatus 300. Cross-sectional views of the coating of the assembled balloon 2200 are shown in Figures 83Ά and 83B. As fully described below, the balloon liner 2200 may be similar to the balloon liner 2100 described above with reference to Figures 69-75C, except for the addition of a depression sleeve that is configured to receive the distal end portion. 332 of the balloon 318 and a first cavity (formed by the depressions of the cover members) that is configured to receive the intermediate portion 335 and the proximal end portion 333 of the balloon 318. As shown in Figures 77 and 83Ά, the balloon liner (or balloon liner assembly) 2200 comprises a first portion of the liner 2201 that is configured to cover at least a portion of the distal end portion of the delivery apparatus that includes the balloon. The balloon liner 2200 may further comprise a second portion of the liner 2203 that is configured to cover the positioning device (Figures 77 and 83A). The balloon liner 2200 may comprise a first cover member 2202 and a second cover member 2204 that are configured to engage each other and 241 removably engage each other (similar to the first shell member 2002 and the second shell member 2004 of the balloon skin 2000). For example, the first cover member 2202 and the second cover member 2204 may comprise two halves of a cover 2206 of the balloon skin 2200 (Figures 77, 83A, and 83B). The balloon liner 2200 may further comprise a vacuum sleeve 2240 (which may also be referred to as a capsule, member, or vacuum tube). The depression sleeve 2240 may be configured to form a shape (e.g., a sunken or depressed shape) of a portion of a balloon of the delivery apparatus (e.g., the radial depression 334 in the distal end portion 332 of the balloon 318). . The depression sleeve 2240 is described in more detail below with reference to the various views of Figures 78-81B. In some embodiments, the balloon liner 2200 may further comprise a coupling element, which in some embodiments may be a tubular sleeve (e.g., outer sleeve) 2264, which is configured to cover at least a portion of the depression sleeve 2240 and depress one or more depression members 2256 of the depression sleeve 2240 in a radially inward direction, towards the central longitudinal axis 2214, to form a 242 negative depression in one or more portions of the globe. In some embodiments, the sleeve 2264 may be further configured to contain the first cover member 2202 and the second cover member 2204 in engagement with each other (e.g., as shown in Figures 83A and 83B). Sleeve 2264 may be the same or similar to sleeve 2064, as described above. The balloon liner 2200 is shown in a disassembled configuration in the exploded view of Figure 77 and in an assembled configuration in the various views of Figures 83A and 83B. Figure 82 shows the first cover member 2202 disassembled from a remainder of the balloon skin 2200. However, since in some embodiments the first cover member 2202 and the second cover member 2204 can be configured the same (e.g. , formed identically), the first cover member shown in Figure 82 may alternatively be the second cover member 2204. Additionally, Figures 78-81B show different views of the depression sleeve 2240 alone. As shown in Figures 77 and 82, in some embodiments, each of the first cover member 2202 and the second cover member 2204 include a first portion (e.g., first cover portion) 2210 and a second portion (for example, second portion of the 243 cover) 2212. In some embodiments, for each of the first cover member 2202 and the second cover member 2204, the first portion 2210 and the second portion 2212 may be continuous with each other. In some embodiments, the second portion 2212 may have a second width 2218 that is greater than a first width 2216 of the first portion 2210, the widths defined in a radial direction relative to a central longitudinal axis 2214 of the balloon skin 2200 (which may be coaxial with a central longitudinal axis of the delivery apparatus when assembled and fitted around the delivery apparatus). In some embodiments, the first width 2216 and the second width 2218 may be diameters. When the first cover member 2202 and the second cover member 2204 are assembled together (e.g., in mating), the first portions 2210 of the first cover member 2202 and the second cover member 2204 may form one portion of the first portion of the liner 2201 (e.g., further including the depression sleeve 2240, as further described below) and defining an elongated cavity 2220 (which, in some embodiments may be referred to as a lumen). The cavity 2220 (Figures 77, 83A, and 83B) can be configured to receive a portion of the distal end of a delivery apparatus and at least a portion of a balloon (e.g., a portion 244 and a proximal end portion in some embodiments) mounted on the distal end portion of the delivery apparatus (e.g., balloon 318 of the distal end portion 309, as shown in Figure 77). For example, the first portion 2210 of the first cover member 2202 (and similarly, the second cover member 2204) comprises an outer surface 2222 and an inner surface 2224 (Figures 77 and 82). The inner surface 2224 may be a mating surface that is configured to mate with or engage with (e.g., have face-to-face contact with) a respective inner surface of the first portion 2210 of the other cover member (e.g., second ) that forms the coating of t...

Claims

1. A prosthetic heart valve, characterized in that it comprises: a frame including a plurality of struts forming a plurality of frame cells disposed between an inlet end and an outlet end of the frame; a plurality of leaflets disposed within the frame; at least one commissure comprising a connecting member disposed across a selected cell of the plurality of frame cells and attached to the frame struts forming the selected cell, and commissure tabs of two adjacent leaflets coupled to the connecting member; and a radiopaque marker disposed on the connecting member of the commissure, wherein the marker is configured to indicate a commissure location of the prosthetic heart valve.

2. The prosthetic heart valve according to claim 1, characterized in that the marker is asymmetrically reflective through an axis that is parallel to a central longitudinal axis of the prosthetic heart valve, the central longitudinal axis extending between the inlet end 299 and the outlet end.

3. The prosthetic heart valve according to claim 2, characterized in that the marker is a letter of an alphabet.

4. The prosthetic heart valve according to any of claims 1-3, characterized in that the marker is sewn to a central region of the joining member.

5. The prosthetic heart valve according to claim 4, characterized in that the marker is disposed on a first side of the connecting member, the first side being disposed opposite a second side of the connecting member to which the commissure tabs are attached, and wherein the first side is a side oriented radially outward from the connecting member.

6. The prosthetic heart valve according to claim 4, characterized in that the marker is disposed on the same side of the connecting member to which the commissure tabs are attached, the side being a radially inwardly oriented side of the connecting member.

7. The prosthetic heart valve according to any of claims 1-3, characterized in that the marker is disposed on a fin of the connecting member extending outwards from a central portion of the connecting member and wherein the fin is folded over a side oriented radially outwards from the central portion so that the marker is disposed between the fin and the side oriented radially outwards from the central portion, and wherein the commissure tabs engage with a side oriented radially inwards from the central portion.

8. The prosthetic heart valve according to claim 7, characterized in that the marker is secured to the flap and to the central portion of the connecting member with a plurality of sutures used to secure the commissure tabs to the central portion of the connecting member and extending through the openings of the marker and the corresponding openings of the flap.

9. The prosthetic heart valve according to any of claims 1-8, characterized in that it further comprises a skirt disposed around the frame of the prosthetic heart valve at the inlet flow end of the frame.

10. The prosthetic heart valve according to any of claims 1-9, characterized in that the joining member comprises a fabric sutured to frame struts forming the selected cell.

11. A prosthetic heart valve, characterized in that it comprises: a frame including a plurality of struts forming a plurality of frame cells disposed between an inlet end and an outlet end of the frame; a plurality of leaflets disposed within the frame; at least one commissure comprising a first connecting member disposed across a selected cell of the plurality of frame cells and attached to the frame struts forming the selected cell, and commissure tabs of two adjacent leaflets coupled to the first connecting member;and a radiopaque marker attached to a second connecting member, the second connecting member disposed across the selected cell and attached to the struts forming the selected cell, the second connecting member disposed outside the first connecting member relative to a central longitudinal axis of the frame, wherein the marker is configured to indicate a prosthetic heart valve commissure location.

12. The prosthetic heart valve according to claim 11, characterized in that the marker is disposed between the first connecting member and the second connecting member.

13. The prosthetic heart valve in accordance with claim 11 or 12, characterized in that the marker is sewn to a central region of the second joining member.

14. The prosthetic heart valve according to any of claims 11-13, characterized in that the marker is asymmetrically reflective through an axis that is parallel to the central longitudinal axis, the central longitudinal axis extending between the inlet end and the outlet end.

15. The prosthetic heart valve according to any of claims 11-14, characterized in that the marker is a letter of an alphabet.

16. The prosthetic heart valve according to any of claims 11-15, characterized in that the second joining member comprises a fabric sutured to frame struts forming the selected cell.

17. The prosthetic heart valve according to any of claims 11-16, characterized in that the first connecting member and the second connecting member are secured to the frame struts forming the selected cell by means of a single connecting line extending through each of the first connecting member and the second connecting member and around the frame struts forming the selected cell.

18. The prosthetic heart valve according to any of claims 11-17, characterized in that the frame is radially compressible and expandable between a radially compressed configuration and a radially expanded configuration and wherein the marker is shaped so as to fit within the selected cell when the frame is in the radially compressed configuration.

19. A prosthetic heart valve, characterized in that it comprises: a frame including a plurality of struts forming a plurality of frame cells disposed between an inlet end and an outlet end of the frame; a plurality of leaflets disposed within the frame; at least one commissure comprising commissure tabs of two adjacent leaflets of the plurality of leaflets connected together, the at least one commissure secured to the frame struts forming a cell selected from the plurality of cells; and a radiopaque marker attached to a connecting member, the connecting member disposed across the selected cell and attached to the struts forming the selected cell, wherein the marker is configured to indicate a location of the prosthetic heart valve commissure.

20. The prosthetic heart valve according to claim 19, characterized in that the frame is radially compressible and expandable between a radially compressed configuration and a radially expanded configuration and wherein the marker is formed so as to fit within the selected cell when the frame 304 is in the radially compressed configuration.

21. The prosthetic heart valve according to claim 19 or 20, characterized in that the marker is asymmetrically reflective through an axis that is parallel to a central longitudinal axis of the frame, the central longitudinal axis extending between the inlet end and the outlet end.

22. The prosthetic heart valve according to claim 21, characterized in that the marker is a letter of the alphabet.

23. The prosthetic heart valve according to any of claims 19-22, characterized in that the commissure tabs of the two adjacent leaflets are coupled to the joining member, on an inner surface of the joining member, and the marker is disposed on an outer surface of the joining member.

24. The prosthetic heart valve according to any of claims 19-22, characterized in that the commissure tabs of the two adjacent leaflets are coupled to the joining member, on an inner surface of the joining member, and the marker is disposed on the inner surface of the joining member.

25. The prosthetic heart valve according to any of claims 19-22, characterized in that the marker is disposed on a fin of the connecting member extending outward from a central region of the connecting member and wherein the fin is folded over a side oriented radially outward from the central region such that the marker is disposed between the fin and the side oriented radially outward from the central region, and wherein the commissure tabs engage with a side oriented radially inward from the central region.

26. The prosthetic heart valve according to any of claims 19-22, characterized in that the connecting member is a first connecting member and wherein the commissure tabs of the two adjacent leaflets are coupled to a second connecting member, the second connecting member arranged across the selected cell and attached to the struts forming the selected cell, the first connecting member being arranged outside the second connecting member relative to a central longitudinal axis of the frame.

27. The prosthetic heart valve according to claim 26, characterized in that the marker is disposed between the first connecting member and the second connecting member and wherein the first connecting member and the second connecting member are secured to the frame struts forming the selected cell by means of a single connecting line extending through each of the first connecting member and the second connecting member and around the frame struts forming the selected cell.

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