A 74 year-old female on hemodialysis and morbid obesity presented with worsening shortness of breath and NYHA class III, associated with increased fatigue. TTE revealed severe aortic stenosis; mean gradient = 42 mmHg, Doppler valve area = 0.81 sq cm, Ao peak CW velocity = 4.30 m/sec, LVEF = 60%. A Cardiac Cath on June 6, 2013 revealed mild pulmonary hypertension, normal coronaries, severe AS and underwent surgical balloon aortic valvuloplasty (BA) with AVA increased from 0.7 to 1.0 sqcm. The STS risk mortality: 14.44%, EuroScore II risk mortality: 4.21% and Logistic Euroscore: 28.13%. Patient was determined to be extreme risk for surgical AVR due to ESRD, obesity (BMI 46.99), immobility and restrictive lung disease. Patient is now planned for CoreValve TAVR (29 mm) via transfemoral percutaneous 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 […]