Page 37 - Journal of Structural Heart Disease Volume 5, Issue 5

Case Report 230
Figure 1. Mean gradient across the bioprosthetic aortic valve of 44 mm Hg indicating severe stenotic process
mal left ventricular ejection fraction (EF) with atrial fibrillation and history of moderate mitral and tricus- pid valve regurgitation. This patient has prior cardiac
history of coronary artery disease (CAD) with a LAD stent placed in 2013. In 2011, a 25 mm Carpentier-Ed- wards Magna pericardial valve was used as an aortic valve replacement. Other past medical history in- cludes: severe chronic obstructive pulmonary disease (COPD) with FEV1 of 0.7 L at 40% predicted, signifi- cant renal insufficiency with creatine around 2.0 mg/ dL, glomerular filtration rate (GFR) of 32 mL/minute and gastrointestinal bleed with baseline hemoglobin between 8.0 and 9.0 g/dL.
This patient complained of exertional dyspnea with frequent hospital admissions due to congestive heart failure. This was associated with progressive stenotic process in the aortic valve prosthesis with the last mean gradient across the aortic valve prothe- sis noted at 44 mmHg (Figure 1). A patient prosthesis mismatch was ruled out due to the mean gradient of 6 mmHg a year post-operatively.
The heart valve team met with this patient to dis- cuss the option of redoing the surgical aortic valve replacement or the transcatheter valve implantation. This case was risk stratified by two cardiac surgeons as a high surgical risk due the calculated STS score of
AB
Figure 2. High coronary occlusion risk. Panel A. Left main coronary ostial height 5.9 mm. Panel B. Surgical frame posts 17 mm slightly higher than STJ 16.7 mm.
Journal of Structural Heart Disease, October 2019 Volume 5, Issue 5:229-236