RT Book, Section
A1 Sidhu, Sunjeet
A1 Chacko, Matthews
A2 Baliga, R. R.
A2 Lilly, Scott M.
A2 Abraham, William T.
SR Print(0)
ID 1160207116
T1 Transcatheter Aortic Valve Replacement
T2 Color Atlas and Synopsis of Interventional Cardiology
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071749350
LK accesscardiology.mhmedical.com/content.aspx?aid=1160207116
RD 2024/04/17
AB An  88-year-old  man  with  a  history  of  hypertension,  insulin-dependent  diabetes  mellitus,  moderate  chronic  obstructive  pulmonary  disease,  and  coronary  artery  disease  with  a  remote  inferior  myocardial  infarction  was  recently  hospitalized  for  decompensated  heart  failure.  He  reported  dyspnea  with  mild  exertion  while  walking  on  level  ground  and  associated  substernal  chest  pressure  consistent  with  New  York  Heart  Association  class  III  heart  failure.  He  also  reported  2-pillow  orthopnea  and  progressive  lower  extremity  edema.  The  physical  exam  demonstrated  a  grade  III/VI  late-peaking  systolic  crescendo-decrescendo  murmur  with  obscuration  of  the  second  heart  sound.  The  carotid  upstrokes  were  blunted  and  delayed.  The  jugular  venous  pressure  was  estimated  at  12  cm  above  the  right  atrium.  A  transthoracic  echocardiogram  demonstrated  normal  left  ventricular  function  with  an  ejection  fraction  of  55%  and  a  calcified  trileaflet  aortic  valve  with  reduced  leaflet  mobility.  Doppler  interrogation  of  the  aortic  valve  demonstrated  a  peak  systolic  velocity  of  4.2  m/s  and  a  mean  systolic  gradient  of  45  mm  Hg.  The  aortic  valve  area,  calculated  by  the  continuity  equation,  was  found  to  be  0.8  cm2.  Based  on  the  physical  exam  and  echocardiography  findings  consistent  with  severe  aortic  stenosis,  his  predicted  risk  of  mortality  with  surgical  aortic  valve  replacement  at  30  days  was  11.5%.