Structural heart cases
TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021

Views 283

Case & Plan:
68-year-old male presents with DOE, lower extremity edema and venous stasis ulcers for 6 months. Past medical history is significant for HTN, CKD, HLD, rectal carcinoid s/p resection in 2001, carcinoid heart disease s/p bioprosthetic TVR in 2006 (33mm perimount plus 6900) and LAA excision, AF not on anticoagulation due to h/o GI bleed, alcoholic cirrhosis (Child-Pugh class B), HFrEF (now recovered) s/p BiV- ICD in 2010 with recent RV ICD lead re-positioning in to SVC (Jan 2021). Recent TEE revealed LVEF of 43% and abnormal tricuspid bioprosthesis with stenosis [mean gradient 13.3mmHg and two of the three leaflets (anterior and posterior) heavily calcified, fixed and restricted]. STS Risk for redo-TVR was calculated at 8.16%. Heart Team evaluation found him to be high risk for redo TVR due to associated medical comorbidities. Now planned for tricuspid valve-in-valve implantation (TVIV) via right percutaneous femoral venous access using a 29 (+2cc) mm SAPIEN-3 valve.

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TVIV using a 29 (+2cc) mm SAPIEN-3 Valve – March 2021 (Edited Version)
Views 284

Case & Plan: 68-year-old male presents with DOE, lower extremity edema and venous stasis ulcers for 6 months. Past medical history is significant for HTN, CKD, HLD, rectal carcinoid s/p resection in 2001, carcinoid heart disease s/p bioprosthetic TVR in 2006 (33mm perimount plus 6900) and LAA excision, AF not on anticoagulation due to h/o […]


Transfemoral ViV TAVR using 23mm Evolut Pro+ Valve with Sentinel Cerebral Embolic Protection Device – May 2021
Views 285

Case & Plan: 73-year-old male presents with worsening NYHA Class III symptoms of heart failure for the last 4-5 months. Past medical history is significant for severe restrictive lung disease, home oxygen use, HTN, HLD, IDDM, OA, CAD and aortic stenosis s/p AVR and CABG (in 2012 with 21mm MitroFlow bio-prosthetic valve and LIMA to […]


TF-TAVR using 20mm SAPIEN S3 Ultra Valve in a Centenarian Patient – January 2021
Views 349

  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
Views 245

  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 […]