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 (Mini-crush technique- Rota guided, Impella supported DES-PCI) on 03/17/20. He was discharged the next day. Pt was readmitted 2 days later at an OSH via EMS due to breathlessness and unresponsiveness. He had transient cardiac arrest and was successfully resuscitated. He was also intubated due to impending respiratory failure, and was started on vasopressors and diuretics. EKG showed no acute ischemic changes with troponin of 0.59 and COVID was negative. He was transferred to MSH. A repeat cath showed patent stents with moderate pulmonary artery hypertension and markedly elevated PCW pressure (mean/V wave: 30/55). An IABP was placed. A subsequent TEE showed severe eccentric MR with flail A2. Heart team found him to be an appropriate candidate for urgent MitraClip procedure given the COVID pandemic. He underwent a successful MitraClip procedure following which he was extubated and IABP was removed. He was discharged 3 days later.
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.
Explanation for Reduced MI during COVID-19 Pandemic
Samin K. Sharma, MD