Case and Plan:
91-year-old female with hypertension, hypothyroid and chronic diastolic heart failure (HFpEF) presents with progressive exertional dyspnea and NYHA CCS Class III for the past few weeks. She also had a recent hospitalization at OSH for flash pulmonary edema and heart failure exacerbation requiring IV diuretics and thoracentesis. Echo revealed severe calcified aortic valve stenosis with AVA/PG/MG/PV of 0.6/72/49/4.2 with EF of 60%. Recent angiogram revealed non-obstructive CAD. The aortic annulus measured 19.5 x 25.6 mm (mean 22.6 mm), annular perimeter was 72.6 mm and the annular area was 406.4 mm2. The STS mortality risk for surgical AVR was 3.73% and the logistic Euroscore mortality risk was 15.2. The patient underwent Heart Team evaluation and was found to be at high risk for SAVR due to comorbidities, advanced age and frailty. Analysis of lower extremity on CT angiogram revealed severe calcified peripheral arterial disease with tortuosity not adequate diameter for trans-femoral approach. The dimensions of the right common femoral artery and right external iliac arteries were less than 5.5mm. So, patient now presents for TAVR with 26 mm Evolut-R CoreValve via a right femoral percutaneous approach with extracorporeal shockwave lithotripsy (ESWL) of right iliac artery and possible Sentinel cerebral protection device.
Echo Guided Alcohol Septal Ablation (ASA) for Refractory Symptomatic HOCM – July 2019
64 year-old morbidly obese female with known hypertrophic obstructive cardiomyopathy (HOCM), presents with progressive exertional dyspnea NYHA CCS Class III. Echo revealed severe asymmetric septal hypertrophy (ASH) with septal thickness of 21 mm and systolic anterior motion (SAM) of anterior mitral valve leaflet, high LVOT gradient, hyperdynamic LV and mild to moderate MR with severe […]
Mitral ViV TMVR using SAPIEN-3 Valve – May 2019
81 year old female presents with worsening dyspnea on minimal exertion (NYHA class III) over the last few months. Her past medical history is significant for rheumatic heart disease with severe MR and MS s/p bioprosthetic MVR with 29 mm porcine valve (Biocor, St. Jude Medical) along with MAZE procedure in 2007. She also has […]
Valve-in-Valve TAVR with 26mm SAPIEN-3 – March 2019
79 year old man presents with worsening exertional dyspnea (NYHA Class III) for the last 3 months. Patient has required multiple recent admissions to hospital with CHF exacerbation requiring IV diuretics. Past medical history is significant for symptomatic bicuspid aortic valve with dilated ascending aorta s/p Bentall procedure (2011) with 25 mm Carpentier-Edwards pericardial valve […]
Valve-in-Valve TAVR with 29mm Evolut-R CoreValve – January 2019
79 year old man presents with progressive exertional dyspnea (NYHA Class III) for the last 2 months.