A 76 year-old female with H/O multiple PCI’s and metastatic breast cancer presented with progressive symptomatic severe aortic stenosis, confirmed on cath with AVA 0.6 sq cm. TTE revealed severe AS, peak/mean aortic gradient = 64/48 mmHg, AVA = 0.6 sq cm, aortic peak velocity = 4.2 m/sec and LVEF 60%. CT angio showed minimum diameters of 0.8 x 0.8 cm for Right and 0.8 x 0.7 cm for the Left common femoral arteries and aortic annulus of 2.1 x 2.7 cm (average 2.4). The STS risk mortality is 4.2 and the Logistic Euroscore mortality is 11.7. Patient was determined to be extreme risk for surgical AVR due to metastatic cancer (responding to chemotherapy) with projected life expectancy of 2-3 years. Patient is now planned for CoreValve TAVR (29mm) via percutaneous femoral access under conscious sedation.
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 […]
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 […]