Structural heart cases
Mitral ViV TMVR using SAPIEN-3 Valve – May 2019

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81 year old female presents with worsening dyspnea on minimal exertion (NYHA class III) over the last few months. Her past medical history is significant for rheumatic heart disease with severe MR and MS s/p bioprosthetic MVR with 29 mm porcine valve (Biocor, St. Jude Medical) along with MAZE procedure in 2007. She also has persistent atrial fibrillation on warfarin. A recent TEE showed degeneration of the bioprosthesis with flail leaflet and severe MR with posteriorly directed MR jet. The transmitral gradient across the bioprosthesis was 8mmHg. There was diastolic flow predominance in the right and left upper pulmonary veins consistent with severe MR. The patient was evaluated by the Heart Team and was deemed high risk (STS
mortality 10.75%) for re-op surgical mitral valve replacement due to her advanced frailty and comorbidities. The patient is now planned for a mitral ViV TMVR with a 26 mm (+3 cc) Sapien-3
valve via transfemoral approach.

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TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021
Views 156

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
Views 202

  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
Views 164

  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
Views 314

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.