Echo Guided Alcohol Septal Ablation (ASA) for Refractory Symptomatic HOCM – July 2019
64 year-old morbidly obese female with known hypertrophic obstructive cardiomyopathy (HOCM), presents with progressive exertional dyspnea NYHA CCS Class III. Echo revealed severe asymmetric septal hypertrophy (ASH) with septal thickness of 21 mm and systolic anterior motion (SAM) of anterior mitral valve leaflet, high LVOT gradient, hyperdynamic LV and mild to moderate MR with severe MAC and transmitral gradient of 9 mmHg. MRI confirmed echo findings and also revealed systolic obliteration of LV cavity with scattered patchy minimal necrosis. Cardiac Cath revealed 70 mmHg gradient at rest at mid cavity level with positive Brockenbrough-Braunwald-Morrow sign with gradient of 180 mmHg and no CAD. Patient remains symptomatic despite being on maximum tolerated medical therapy. Patient is now planned for echo guided alcohol septal ablation (ASA) for refractory symptomatic HOCM.
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 […]
TAVR with 26mm SAPIEN-3 Ultra Valve via Right Femoral Percutaneous – January 2020
Tags: Structural | Structural heart | TAVR
Case and Plan: 81-year-old female with hypertension, ex-smoker, and chronic diastolic heart failure now presents with progressive exertional dyspnea NYHA Class III for the past month after walking up to 1 block. She was noted to have right lower lobe subsegmental pulmonary embolism on recent CT with evidence of old DVT requiring anticoagulation. Echo revealed […]