84 year old female presented with chest pain and dyspnea on exertion (NYHA III). Her past history was significant for hypertension, hyperlipidemia, and DVT. TTE revealed severe valvular aortic stenosis; peak gradient = 68 mmHg, mean gradient = 41 mmHg, Doppler valve area = 0.7cm2, Aortic peak velocity = 4.1m/sec and LVEF of 51 %. Coronary angiogram showed mild (30-50%) mid LAD disease only. CT angiogram revealed minimum diameters of 8mm for bilateral common iliac arteries and aortic annulus of 21.6 X 26.7mm (average 24.4 mm) with an annular circumference of 75mm. Coronary ostial height was 10mm for left main and 15mm for RCA. The STS mortality risk for Surgical AVR is 3.4 % and the Logistic Euroscore mortality risk is 10.1%. Patient was determined to be intermediate risk for SAVR. Now planned for high risk TAVR with Sapien S3 (26mm) via percutaneous femoral access under conscious sedation and pre-empt LM protection.
TF-TAVR using 20mm SAPIEN S3 Ultra Valve in a Centenarian Patient – January 2021
Case and Plan: 104 year-old-female with cardiomyopathy, kyphoscoliosis, pleural effusion s/p thoracentesis, NSVT now presents with progressive exertional dyspnea (NYHA Class III) for few months. Patient underwent urgent balloon aortic valvuloplasty in August 2020 in setting of acute congestive heart failure and severe aortic stenosis. Recent transthoracic echocardiogram revealed LVEF of 35% and severe […]
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 […]