An 84 year-old male presented with progressive shortness of breath and chest discomfort – NYHA class II, with a history of hypertension, I vessel CAD, COPD, TIA, s/p BAV on 10/2/15, s/p rt. radical nephrectomy, stage III CKD, and h/o CA prostrate. TTE revealed severe AS, peak/mean aortic gradient = 85/56 mmHg, AVA = 0.8 sq cm, aortic peak velocity = 4.6 m/sec and LVEF 77%. CT angio showed minimum diameters of 0.7 x 0.8 cm for right and 0.7 x 0.7 cm for left common femoral arteries and aortic annulus of 2.6 X 2.2 cm (average 2.4 cm). The STS risk mortality is 9.5 % and the Logistic Euroscore mortality is 20.27 %. Patient was determined to be very high risk for surgical AVR due to advanced age, high right diaphragm, renal insufficiency, COPD, and obesity. Patient is now planned for CoreValve Evolut-R TAVR (29mm) via percutaneous femoral access under conscious sedation.
Bioprosthetic Aortic ViV TAVR after Valve Fracture and Evolut Pro+ Implantation – November 2020
Case and Plan: 60 year-old male presents with worsening exertional dyspnea (NYHA Class III) and multiple admissions for CHF exacerbation in past 3 months. Past medical history is significant for symptomatic severe aortic insufficiency s/p bioprosthetic AVR (2017) with 23mm Magna 3000 valve, ESRD on HD, HTN and HLD. Recent echocardiogram revealed bioprosthetic valve […]
TF-TAVR with No Contrast – September 2020
Case and Plan: 61 year-old-male with ETOH abuse, hepatitis and cirrhosis s/p Liver transplant in 6/2019 at MSH with postop course notable for AKI requiring dialysis (last dialysis 7/6/2019), Hypertension, Anemia, Former smoker, CKD stage III.
Urgent Appropriately Indicated MitraClip Procedure in Patient with Cardiogenic Shock in Covid-19 Era – May 2020
Case and Plan: 74-year-old male former smoker with PMHx of HTN, HLD, and A Fib (on Eliquis) had IW-STEMI on 02/09/20. Cath showed occluded mRCA with dLM bifurcation disease; S/p DES-PPCI to mRCA. Transthoracic echocardiogram at the time of discharge showed an EF of 55% with moderate MR. Pt had staged PCI to dLM […]
TAVR using Transcarotid Access – March 2020
Tags: TAVR | Transcarotid Access
Case and Plan: 73-year-old male with hypertension, hyperlipidemia, parathyroidectomy, renal cell carcinoma s/p nephrectomy and right renal transplant in 2001 on chronic steroids and immunosuppressant therapy, paroxysmal atrial fibrillation on AC with warfarin, chronic diastolic heart failure and severe PAD presents with progressive exertional dyspnea NYHA-Class III for the past month after walking up to […]