88 year old female presented with chest pain and progressive dyspnea on exertion (NYHA Class III). Past medial history is significant for hypertension, hyperlipidemia, DM, AF on Coumadin, PPM, CABG, Colorectal Carcinoma, Anemia and OSA. TTE revealed severe aortic stenosis (peak gradient = 68 mmHg, mean gradient = 42 mmHg, Doppler valve area = 0.64 cm2, Aortic peak velocity = 4.13m/sec) and LVEF of 62 %. Coronary angiogram showed II Vessel CAD and patent grafts. CT angiogram revealed minimum diameters of ≥ 6.5 mm for bilateral common iliac arteries and aortic annulus of 21 X 26 mm (average 23.5 mm) with an annular circumference of 75 mm and perimeter derived diameter of 24mm. Coronary ostial height was 16 mm on left and 15 mm on the right. The STS mortality risk is 13.86 % and the Logistic Euroscore mortality risk is 49.15%. Patient was determined to be at extreme risk for SAVR due to co-morbidities. Pt is now planned for transfemoral TAVR with EVOLUT-R (29 mm) via percutaneous femoral access under conscious sedation.
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 […]