Case & Plan:
Patient Demographics:
83 yrs, Male
Present Clinical Presentation:
Presented @OSC 1/23 with progressive angina and DOE with cath revealing 3V+LM CAD and severe AS, failed attempted PCI of RCA
CAD Risk Factors:
Controlled Hyperlipidemia
Controlled Hypertension
Controlled NIDDM
SAQ-7 score: 45 TIA, BPH
Clinical Variables:
Known moderate CAD on cath in the past and was managed medically. Also known to have progressive AS and moderate LV dysfunction
Medications:
ASA, Clopidogrel, Metoprolol XL, Amlodipine, Rosuvastatin, Metformin
Cath: Cath on 1/18/2023 in Philippines revealed extensive calcified 3 V+LM CAD: 95% calcified prox RCA lesions, 70% dLM, 90% calcified prox LAD, 80% mid LAD, 70% D1, 70% prox LCx-OM1, LVEF 40% and Syntax score 36 and STS risk 5.2%. PCI of RCA attempted but failed. Echo revealed severe AS (PG/MG/PV/AVA; 68/49/4.2/0.6), mod MR and mild pulm HTn, CT revealed AV anatomy appropriate for TAVR. Heart team discussion recommended high risk Protected PCI+ BAV as bridge to TAVR.
Plan: Now planned for BAV followed by Impella supported high risk PCI of RCA/LM/LAD lesions using RotaTripsy.
