67 year old male presents with worsening dyspnea on exertion (NYHA class III) and edema over the last 4 weeks. Past medical history is significant for severe MR s/p bioprosthetic MVR in 1997 with subsequent degeneration and replacement with a #29 Hancock II porcine bioprosthetic valve in 2008. Patient had mitral paravalvular leak s/p transcatheter closure. Also had severe TR s/p Tricuspid Valve Repair (#26 Cosgrove Band) 2008, atrial flutter and atrial fibrillation s/p multiple ablations and s/p Cryomaze in 2008, cirrhosis, CKD stage 3, remote GI bleed, COPD, and severe pulmonary hypertension. A recent TEE showed a severely degenerated mitral valve bioprosthesis with a flail leaflet and severe transvalvular MR along with moderate bioprosthetic MV stenosis (MG = 9-11 mmHg). The patient was evaluated by the Heart Team and due to his multiple comorbidities and STS mortality of 7.12%, was found to be extreme risk for a 3rd reoperation. Patient is now planned for a ViV TMVR with a 29 mm Sapien-3 valve via transfemoral approach.
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 […]