Case
83 years old male patient had admitted for exertional dispnea and fatigue. His functional class was NYHA III. Physical exam showed that aortic 3/6 systolic murmur was present. Blood tests were normal. Severe calcific aortic stenosis with moderate aortic regurgitation, bicuspid aortic valve and left ventricular hypertrophy was detected on transthoracic and transesophageal echocardiogram. aortic root and ascending aorta were found to be enlarged as 30 mm and 45 mm respectively. Coronary angiogram has showed no significant stenosis. He had severe chronic obstructive pulmonary disease and assesed as high risk for surgical aortic valve replacement. Because of bicuspid valve, CoreValve system were chosen as transcatheter aortic valve. During procedure, patient had hemodynamic compromise. Under emergency conditions, CoreValve system was implanted. After rescussitative attemps, spontaneus circulation and sinus rhythm obtained. Prosthetic valve implanted more superiorly than initially planned. Simultaneous pressure recordings from aorta and left ventricle showed no significant gradient. Due to anatomic properties of assending aorta and prosthetic valve size, procedural success assumed as optimal. Follow up echocardiographic and hemodynamic parameters were stable but persistent complete AV block developed and DDDR permanent pacemaker has implanted and patient discharged after 7 days after procedure. After a month, patient course was uneventful.
Case
83 years old male patient had admitted for exertional dispnea and fatigue. His functional class was NYHA III. Physical exam showed that aortic 3/6 systolic murmur was present. Blood tests were normal. Severe calcific aortic stenosis with moderate aortic regurgitation, bicuspid aortic valve and left ventricular hypertrophy was detected on transthoracic and transesophageal echocardiogram. aortic root and ascending aorta were found to be enlarged as 30 mm and 45 mm respectively. Coronary angiogram has showed no significant stenosis. He had severe chronic obstructive pulmonary disease and assesed as high risk for surgical aortic valve replacement. Because of bicuspid valve, CoreValve system were chosen as transcatheter aortic valve. During procedure, patient had hemodynamic compromise. Under emergency conditions, CoreValve system was implanted. After rescussitative attemps, spontaneus circulation and sinus rhythm obtained. Prosthetic valve implanted more superiorly than initially planned. Simultaneous pressure recordings from aorta and left ventricle showed no significant gradient. Due to anatomic properties of assending aorta and prosthetic valve size, procedural success assumed as optimal. Follow up echocardiographic and hemodynamic parameters were stable but persistent complete AV block developed and DDDR permanent pacemaker has implanted and patient discharged after 7 days after procedure. After a month, patient course was uneventful.
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