88 year old female presented with chest pain and progressive dyspnea on exertion (NYHA Class III). Past medial history is significant for hypertension, hyperlipidemia, DM, AF on Coumadin, PPM, CABG, Colorectal Carcinoma, Anemia and OSA. TTE revealed severe aortic stenosis (peak gradient = 68 mmHg, mean gradient = 42 mmHg, Doppler valve area = 0.64 cm2, Aortic peak velocity = 4.13m/sec) and LVEF of 62 %. Coronary angiogram showed II Vessel CAD and patent grafts. CT angiogram revealed minimum diameters of ≥ 6.5 mm for bilateral common iliac arteries and aortic annulus of 21 X 26 mm (average 23.5 mm) with an annular circumference of 75 mm and perimeter derived diameter of 24mm. Coronary ostial height was 16 mm on left and 15 mm on the right. The STS mortality risk is 13.86 % and the Logistic Euroscore mortality risk is 49.15%. Patient was determined to be at extreme risk for SAVR due to co-morbidities. Pt is now planned for transfemoral TAVR with EVOLUT-R (29 mm) via percutaneous femoral access under conscious sedation.
79 year old man presents with progressive exertional dyspnea (NYHA Class III) for the last 2 months.
96 year old male presents with progressive exertional dyspnea (NYHA Class III) for the last 4 months.
87 year old female presents with progressive exertional dyspnea (NYHA Class III) for the last 3 months.
87 year old male with known history of mitral regurgitation, hypertension, hyperlipidemia, CAD s/p DES PCI to RCA (2010 and 2015), ischemic cardiomyopathy, carotid artery stenosis, and frailty presents with worsening dyspnea on exertion NYHA Class III for 6 months.