A 74 year-old female on hemodialysis and morbid obesity presented with worsening shortness of breath and NYHA class III, associated with increased fatigue. TTE revealed severe aortic stenosis; mean gradient = 42 mmHg, Doppler valve area = 0.81 sq cm, Ao peak CW velocity = 4.30 m/sec, LVEF = 60%. A Cardiac Cath on June 6, 2013 revealed mild pulmonary hypertension, normal coronaries, severe AS and underwent surgical balloon aortic valvuloplasty (BA) with AVA increased from 0.7 to 1.0 sqcm. The STS risk mortality: 14.44%, EuroScore II risk mortality: 4.21% and Logistic Euroscore: 28.13%. Patient was determined to be extreme risk for surgical AVR due to ESRD, obesity (BMI 46.99), immobility and restrictive lung disease. Patient is now planned for CoreValve TAVR (29 mm) via transfemoral percutaneous access under conscious sedation.
