Structural heart cases
Echo Guided Alcohol Septal Ablation (ASA) for Refractory Symptomatic HOCM – July 2019

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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 MAC and transmitral gradient of 9 mmHg. MRI confirmed echo findings and also revealed systolic obliteration of LV cavity with scattered patchy minimal necrosis. Cardiac Cath revealed 70 mmHg gradient at rest at mid cavity level with positive Brockenbrough-Braunwald-Morrow sign with gradient of 180 mmHg and no CAD. Patient remains symptomatic despite being on maximum tolerated medical therapy. Patient is now planned for echo guided alcohol septal ablation (ASA) for refractory symptomatic HOCM.

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TAVR with 26mm SAPIEN-3 Ultra Valve via Right Femoral Percutaneous – January 2020
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Case and Plan: 81-year-old female with hypertension, ex-smoker, and chronic diastolic heart failure now presents with progressive exertional dyspnea NYHA Class III for the past month after walking up to 1 block. She was noted to have right lower lobe subsegmental pulmonary embolism on recent CT with evidence of old DVT requiring anticoagulation. Echo revealed […]


TF-TMVR USING 29MM SAPIEN-3 VALVE – November 12 , 2019
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90-year-old female with HTN, CKD-3, s/p CABG, RHD with s/p bio-prosthetic MVR (31mm bovine tissue valve in 2003) for severe mitral regurgitation and LAA resection now presents with fatigue, exertional dyspnea and pedal edema. EKG showed A-fib with controlled ventricular rate. Recent TTE on 9/19/19 showed moderate to severe bioprosthetic mitral stenosis with mild MR, […]


Evolut-R CoreValve TAVR case with difficult vascular access via percutaneous femoral approach utilizing Shockwave Lithotripsy – September 2019
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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 […]


Mitral ViV TMVR using SAPIEN-3 Valve – May 2019
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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 […]