Structural heart cases
TAVR using Transcarotid Access – March 2020

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 1 block which is relieved by rest. Echo revealed severe calcified trileaflet aortic valve stenosis with AVA/PG/MG/PV of 0.7/73/41/4.3 with EF of 65%. Recent angiogram revealed non-obstructive CAD. The aortic annulus measured 21.8 x 28.5 mm (mean-25.1mm), annular perimeter was 80.1mm and the annular area was 493.5 mm2. The STS mortality risk for surgical AVR was 3.6%. The patient underwent Heart Team evaluation and was found to be at very high risk for SAVR due to comorbidities, and frailty. Analysis of lower extremity on CT angiogram revealed severe calcification of femoral arteries and transplanted kidney on the right side. Considering his poor femoral anatomy, options of alternative accesses were considered. Therefore, TAVR with a 26 mm SAPIEN-3 Ultra valve is planned via right carotid cutdown approach.

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Your email address will not be published.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 371

 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 with 26mm SAPIEN-3 Ultra Valve via Right Femoral Percutaneous – January 2020
Tags: | |
Views 427

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 406

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, […]


Evolut-R CoreValve TAVR case with difficult vascular access via percutaneous femoral approach utilizing Shockwave Lithotripsy – September 2019
Tags: | |
Views 695

Case and Plan: 91-year-old female with hypertension, hypothyroid and chronic diastolic heart failure (HFpEF) presents with progressive exertional dyspnea and NYHA CCS Class III for the past few weeks. She also had a recent hospitalization at OSH for flash pulmonary edema and heart failure exacerbation requiring IV diuretics and thoracentesis. Echo revealed severe calcified aortic […]