Structural heart cases
Transfemoral TAVR Evolut-R (29 mm) via Percutaneous Femoral Access – March 2017
Views 1733

88 year old female presented with chest pain and progressive dyspnea on exertion (NYHA Class III). Past medial history is significant for hypertension, hyperlipidemia, DM, AF on Coumadin, PPM, CABG, Colorectal Carcinoma, Anemia and OSA. TTE revealed severe aortic stenosis (peak gradient = 68 mmHg, mean gradient = 42 mmHg, Doppler valve area = 0.64 cm2, Aortic peak velocity = 4.13m/sec) and LVEF of 62 %. Coronary angiogram showed II Vessel CAD and patent grafts. CT angiogram revealed minimum diameters of ≥ 6.5 mm for bilateral common iliac arteries and aortic annulus of 21 X 26 mm (average 23.5 mm) with an annular circumference of 75 mm and perimeter derived diameter of 24mm. Coronary ostial height was 16 mm on left and 15 mm on the right. The STS mortality risk is 13.86 % and the Logistic Euroscore mortality risk is 49.15%. Patient was determined to be at extreme risk for SAVR due to co-morbidities. Pt is now planned for transfemoral TAVR with EVOLUT-R (29 mm) via percutaneous femoral access under conscious sedation.



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Urgent Appropriately Indicated MitraClip Procedure in Patient with Cardiogenic Shock in Covid-19 Era – May 2020
Views 397

 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, […]