Structural heart cases
CoreValve TAVR (29mm) via Transfemoral Percutaneous Access – Feb 2015
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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.

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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 […]


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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 […]