Structural heart cases
SAPIEN 3 TAVR (26mm) via Percutaneous Femoral Access – January 2017
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84 year old female presented with chest pain and dyspnea on exertion (NYHA III). Her past history was significant for hypertension, hyperlipidemia, and DVT. TTE revealed severe valvular aortic stenosis; peak gradient = 68 mmHg, mean gradient = 41 mmHg, Doppler valve area = 0.7cm2, Aortic peak velocity = 4.1m/sec and LVEF of 51 %. Coronary angiogram showed mild (30-50%) mid LAD disease only. CT angiogram revealed minimum diameters of 8mm for bilateral common iliac arteries and aortic annulus of 21.6 X 26.7mm (average 24.4 mm) with an annular circumference of 75mm. Coronary ostial height was 10mm for left main and 15mm for RCA. The STS mortality risk for Surgical AVR is 3.4 % and the Logistic Euroscore mortality risk is 10.1%. Patient was determined to be intermediate risk for SAVR. Now planned for high risk TAVR with Sapien S3 (26mm) via percutaneous femoral access under conscious sedation and pre-empt LM protection.

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Urgent Appropriately Indicated MitraClip Procedure in Patient with Cardiogenic Shock in Covid-19 Era – May 2020
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 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
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Views 305

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
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Views 439

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 […]


TF-TMVR USING 29MM SAPIEN-3 VALVE – November 12 , 2019
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Views 423

90-year-old female with HTN, CKD-3, s/p CABG, RHD with s/p bio-prosthetic MVR (31mm bovine tissue valve in 2003) for severe mitral regurgitation and LAA resection now presents with fatigue, exertional dyspnea and pedal edema. EKG showed A-fib with controlled ventricular rate. Recent TTE on 9/19/19 showed moderate to severe bioprosthetic mitral stenosis with mild MR, […]