87 year old male with known history of mitral regurgitation, hypertension, hyperlipidemia, CAD s/p DES PCI to RCA (2010 and 2015), ischemic cardiomyopathy, carotid artery stenosis, and frailty presents with worsening dyspnea on exertion NYHA Class III for 6 months. A transthoracic echocardiogram showed LVEF 30%, moderately dilated LV (LVIDs 4.8 cm, LVIDd 6.3 cm) with severe global hypokinesis, mildly dilated LA, and severe mitral regurgitation. A subsequent transesophageal echocardiogram (TEE) revealed a moderately dilated LV with annular dilation, partial prolapse of the posterior mitral valve leaflet with severe centrally-directed mitral regurgitation involving the A2/P2 segment and no mitral stenosis. The STS mortality risk for surgical MVR is 4.1% and the logistic Euroscore mortality risk is 13.1%. The patient underwent a Heart Team evaluation and was found to be prohibitive risk for surgical MVR due to comorbidities, advanced age and frailty. Patient is now planned for edge-to-edge mitral valve repair with MitraClip via a transfemoral venous access and transseptal puncture.
TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021
Case & Plan: 68-year-old male presents with DOE, lower extremity edema and venous stasis ulcers for 6 months. Past medical history is significant for HTN, CKD, HLD, rectal carcinoid s/p resection in 2001, carcinoid heart disease s/p bioprosthetic TVR in 2006 (33mm perimount plus 6900) and LAA excision, AF not on anticoagulation due to h/o […]
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.