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 severe calcified trileaflet aortic valve stenosis with AVA/PG/MG/PV of 0.8/64/42/4 with EF of 65%. Recent angiogram revealed non-obstructive CAD. The aortic annulus measured 22.9 x 25.9 mm (mean 24.4 mm), annular perimeter was 76.4 mm and the annular area was 460.6 mm2. The STS mortality risk for surgical AVR was 2.7% and the logistic Euroscore mortality risk was 4.3%. The patient underwent Heart Team evaluation and was found to be at intermediate risk for SAVR. Analysis of lower extremity CT angiogram revealed severe tortuosity of the abdominal aorta with moderate calcification of femoral arteries. CTA also revealed arteria lusoria – aberrant right subclavian artery arising from the distal arch with a retroesophageal course and a thrombosed saccular aneurysm making the anatomy not favorable for Sentinel cerebral embolic protection device. So, patient is planned for TAVR with a 26 mm SAPIEN-3 Ultra valve via right femoral percutaneous approach.
TF-TAVR using 20mm SAPIEN S3 Ultra Valve in a Centenarian Patient – January 2021
Case and Plan: 104 year-old-female with cardiomyopathy, kyphoscoliosis, pleural effusion s/p thoracentesis, NSVT now presents with progressive exertional dyspnea (NYHA Class III) for few months. Patient underwent urgent balloon aortic valvuloplasty in August 2020 in setting of acute congestive heart failure and severe aortic stenosis. Recent transthoracic echocardiogram revealed LVEF of 35% and severe […]
Bioprosthetic Aortic ViV TAVR after Valve Fracture and Evolut Pro+ Implantation – November 2020
Case and Plan: 60 year-old male presents with worsening exertional dyspnea (NYHA Class III) and multiple admissions for CHF exacerbation in past 3 months. Past medical history is significant for symptomatic severe aortic insufficiency s/p bioprosthetic AVR (2017) with 23mm Magna 3000 valve, ESRD on HD, HTN and HLD. Recent echocardiogram revealed bioprosthetic valve […]
TF-TAVR with No Contrast – September 2020
Case and Plan: 61 year-old-male with ETOH abuse, hepatitis and cirrhosis s/p Liver transplant in 6/2019 at MSH with postop course notable for AKI requiring dialysis (last dialysis 7/6/2019), Hypertension, Anemia, Former smoker, CKD stage III.
Urgent Appropriately Indicated MitraClip Procedure in Patient with Cardiogenic Shock in Covid-19 Era – May 2020
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 […]