Structural heart cases
SAPIEN 3 TAVR (23mm) Valve via Percutaneous Femoral Access – Oct 2016

A 89 year-old male presented with worsening dyspnea on exertion– NYHA class III and fatigue, with history of hypertension, hyperlipidemia and multiple prior PCIs. Patient also suffers from mild cognitive impairment as a result of childhood meningitis. TTE revealed severe valvular aortic stenosis; peak gradient = 88 mmHg, mean gradient = 58 mmHg, Doppler valve area = 0.66cm2, Ao peak velocity = 4.7m/sec and LVEF of 63 %. Cardiac cath showed non-obstructive CAD with patent stents. CT angiogram revealed minimum diameters of 10.5mm for bilateral common iliac arteries and aortic annulus of 25.2 X 21.3 mm (average 23.2mm) with an area of 410mm2. The STS mortality risk for Surgical AVR is 1.5% and the Logistic Euroscore mortality risk is 11.3%. Patient was determined to be intermediate risk for SAVR due to age and neurological dysfunction and is now planned for TAVR with Edwards Sapien 3 (23 mm) valve via percutaneous femoral access under conscious sedation.

49:24

comments

Leave a Reply

Your email address will not be published. Required fields are marked *

suggestion
Suggestions
59:42
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
Tags: |
Views 307

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: | |
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
Tags: |
Views 424

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, […]