Structural heart cases
Echo Guided Alcohol Septal Ablation (ASA) for Refractory Symptomatic HOCM – July 2019

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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.

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TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021
Views 151

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 195

  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
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  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 310

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.