Case and Plan:
91-year-old female with hypertension, hypothyroid and chronic diastolic heart failure (HFpEF) presents with progressive exertional dyspnea and NYHA CCS Class III for the past few weeks. She also had a recent hospitalization at OSH for flash pulmonary edema and heart failure exacerbation requiring IV diuretics and thoracentesis. Echo revealed severe calcified aortic valve stenosis with AVA/PG/MG/PV of 0.6/72/49/4.2 with EF of 60%. Recent angiogram revealed non-obstructive CAD. The aortic annulus measured 19.5 x 25.6 mm (mean 22.6 mm), annular perimeter was 72.6 mm and the annular area was 406.4 mm2. The STS mortality risk for surgical AVR was 3.73% and the logistic Euroscore mortality risk was 15.2. The patient underwent Heart Team evaluation and was found to be at high risk for SAVR due to comorbidities, advanced age and frailty. Analysis of lower extremity on CT angiogram revealed severe calcified peripheral arterial disease with tortuosity not adequate diameter for trans-femoral approach. The dimensions of the right common femoral artery and right external iliac arteries were less than 5.5mm. So, patient now presents for TAVR with 26 mm Evolut-R CoreValve via a right femoral percutaneous approach with extracorporeal shockwave lithotripsy (ESWL) of right iliac artery and possible Sentinel cerebral protection device.
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 […]