Echo Guided Alcohol Septal Ablation (ASA) for Refracting Symptomatic HOCM – Oct 2015
79 year-old male with known hypertrophic obstructive cardiomyopathy (HOCM) with progressive exertional dyspnea NYHA CCS Class IIII and mild inferior wall ischemia on stress MPI. Echo revealed asymmetric septal hypertrophy (with septal thickness of 21mm) and systolic anterior motion (SAM) of anterior mitral valve leaflet, high LVOT gradient (rest gradient = 42mmHg; peak stress and Valsalva gradient = 141mmHg) hyperdynamic LV function (70%) and mild to moderate MR. MRI confirmed echo findings and also revealed systolic obliteration of LV cavity with scattered patchy minimal necrosis. Cardiac cath revealed 88 mmHg gradient at rest at mid cavity level with positive Brockenbrough-Braunwald-Morrow sign with gradient of 190 mmHg and moderate mid LAD lesion. Patient remains symptomatic despite being on maximum tolerated dose of calcium channel blocker (& is intolerant to beta blocker). Patient is now planned for echo guided alcohol septal ablation (ASA) for refracting symptomatic HOCM.
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 […]