Introduction and Case Report

SY is 87 years old female with severe symptomatic aortic stenosis and ischemic heart failure presented with dyspnea, angina and syncope despite medical treatment. She had a history of myocardial infarction, hypertension and transient ischemic cerebrovascular event.. TTE confirmed had severe aortic stenosis with heavy calcification and limited expansion. Transesofageal echocardiography (TEE) was shown that a large thrombus (39×14 mm) in left atrial appendix (LAA) extending to left atrium (LA) (Figure 2). She had %90 stenosis in the middle part of her left anterior descending (LAD) artery on coronary angiography. An 3.0×18 mm drug elauting stent was implanted in LAD. The patient’s STS score was %39.8 and logistic Euroscore was %93.5. The conclusion from the Heart Team discussion was that, although this patient was high risk, she would be better served by a transfemoral TAVI procedure. She had decompansated status and hemodynamic properties got worse two weeks after discharged from hospital. She were taken to the intensive care unit. Her systolic blood pressure was 70/40 mmHg and killip class was four. Positive inotropic agents were started. Her urine output was decreased (30 cc/h). The patient was taken haemodialysis treatment during three days. When the patients systolic blood pressure dropped, adrenalin and noradrenelin were started, on the second day of haemodialysis. The patients urine output was completely stopped. We didn’t performed dialysis because of critically hypotension. At that time heart team decided to urgent TAVI operation for patient. An Edwards-Saphien 23 mm aortic bioprothesis was succesfully implated the aortic position without any complication (Figure 3 and 4). The ESW didn’t deployed its LV apex position during the TAVI operation. After the first day of TAVI operation the patients SBP increased 150/90 mmHg and we stopped adrenalin and dopamine. Her urine output was 4000 cc with help of low dose furosemide (4×20 mg/day). After three days of TAVI operation she was transferred to cardiology service. Creatinine levels dramatically decreased after TAVI (Before TAVI creatinine=2.9 mg/dl, after TAVI=1.08 mg/dl). She was discharged from hospital on the fifth day after TAVI.