Page 25 - Journal of Structural Heart Disease Volume 3, Issue 6

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Case Report
Figure 1. Edwards Certitude delivery system.
Figure 2. Three-dimensional TEE showing a heavily calci ed aor- tic valve with severe stenosis.
5) with a Wilkins score of 12 and mean pulmonary artery pressure of 43 mmHg. His left ventricular ejec- tion fraction was 44%, and he showed Class III New York Heart Association symptoms. His medical history also included coronary disease status post-coronary artery bypass graft, peripheral artery disease status post-femoral-femoral artery bypass, porcelain aorta, severe chronic obstructive pulmonary disease, type II diabetes mellitus, and sick sinus syndrome.
After evaluation by a multidisciplinary heart team, the patient was deemed to be a prohibitively high-
Figure 3. TEE short axis view showing a heavily calci ed aortic valve.
risk candidate for surgical aortic valve replacement due to a Society of Thoracic Surgeons mortality risk score greater than 10% and the presence of a porce- lain aorta on imaging studies. Balloon mitral valvu- loplasty was contraindicated due to a high Wilkins score. Therefore, we made the decision to proceed with simultaneous TAVR and TMVR.
Valve analysis was performed using helical com- puted axial tomography (CT) scanning with 3mensio Structural Heart (3mensio Medical Imaging BV, Bil- thoven, Netherlands) and OsiriX three-dimensional
Tandar A. et al.
Simultaneous TAVR and TMVR