An 85 year-old male presented with recent onset worsening of dyspnea on exertion and fatigue (NYHA III). His past history was significant for presence of hypertension, hyperlipidemia, idiopathic pulmonary fibrosis on steroids, Raynaud’s disease, BPH and hypothyroidism. He was known to have severe AS since 2014 and was medically managed. Recent TTE revealed severe valvular aortic stenosis; peak gradient = 65 mmHg, mean gradient = 41 mmHg, Doppler valve area = 0.79cm2, Ao peak velocity = 4.03m/sec and LVEF of 57 %. Coronary angiogram showed 60% mid LAD disease which was non-significant by FFR. CT angiogram revealed minimum diameters of 8.5mm for bilateral common iliac arteries and aortic annulus of 26.1 X 26.8 mm (average 26.5mm) with an annular circumference of 85mm. The STS mortality risk for Surgical AVR is 5.6% and the Logistic Euroscore mortality risk is 12.4%. Patient was determined to be high risk for SAVR due to age, lung disease and chronic steroid therapy and is now planned for TAVR with EVOLUT R CoreValve (34 mm) via percutaneous femoral access under conscious sedation.
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 […]
TAVR with 26mm SAPIEN-3 Ultra Valve via Right Femoral Percutaneous – January 2020
Tags: Structural | Structural heart | TAVR
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 […]