SUMMARY - American Society of...
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Transcript of SUMMARY - American Society of...
SUMMARY:
Clinical History Aortic stenosis PPM: MedtronicAtrial fibrillation w/AVN Ablation and PPMHypertension Sleep ApneaAAAHeart Failure
Allergy: NKDA
92 y.o. Female
STS 7.5%
NYHA Class III
Cr-1.69
Hb-13.1
PLT-152
INR-2.4
BNP-202
FEV1: N/A
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AV Nodal Ablation
STS SCORE
STS Score
ECG
ECG•AV Paced
Medtronic PPM
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Electrocardiogram
ECHOCARDIOGRAPHY
Required MeasurementsAVA 0.47 cm2 Peak Velocity 4.23 m/s
AVA index 0.3 cm2/m2 Annulus Diameter
Mean Gradient 50 mmHg Ejection Fraction 55-60%
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Findings• Severe BAE •Severe AS• Moderate AI and TR• Mild MR •Moderate Pulmonary
hypertension
Echo findings
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Outside hospital echo reports
ECHO FINDINGS
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Echocardiography Mean gradient 59 mmHg, AVA:�Moderate AI
CAROTID ULTRASOUND
CORONARY ANGIOGRAM
CT – AORTIC ANNULUS AREA
3MENSIO
CT: Coronary Artery Distance
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LM: 16.9 mmRCA: 15.3 mm
CT: Extremities and abdomen Measurement
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Findings were that calcified atheroma WNL in common iliac arteries. Tortuous external iliacs. Mild atheroma in the right common femoral artery and mild to moderate in left common femoral artery. Left renal artery stenosis.
LOWER EXTREMITIES VESSEL
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Right Left
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A dedicated image of the lower extremities.
PERIPHERAL SIZING- SMALLEST DIAMETERS
Minimal Luminal Diameters
Right Left
Common Iliac 7.9 mm Common Iliac 9.3 mm
External Iliac 9.5 mm External Iliac 8.6 mm
Common Femoral 8.8 mm Common Femoral 7.9 mm
Performed CT Angio on 10/2015
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PROCEDURAL PLAN:
This patient is suitable for Transfemoral
Annulus Diameter Measurement
THV Valve SizeProposed
Femoral Access SideProposed for TF Only
or TA
Smallest Vessel Diameter
Measurement
Osirix: 390mm2 23mm S3 TF 7mmEIA
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Groin Cut Downs BAV Size Bypass Size P. Pacer
Left: pigtailRight: TAVR
access
NA (moderate AI)
A: 15V: 22 NA
Allergy: Sternotomy: Yes
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BAV: BALLOON ANGIO
TEE ASSESSMENT: PRE
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TEE assessment of AI
TEE ASSESSMENT: PRE
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AI vena contracta measures 0.15cm2 by planetary using Philips X plane
TEE ASSESSMENT: PRE
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Measurements taken in Philips Xplane for LVOT and coronary anatomy.
TEE ASSESSMENT: PRE
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Planetary of AV multiple attempts in Xplane
DEPLOYMENT OF VALVE
TEE: POST IMPLANT 3D
DISCHARGE
POD: 2 days discharged to homeEcho F/U: 30 days postClinic F/U : 30 days post
