A 78 year old female, diabetic, overweight and hypertensive presented with severe shortness of breath, orthopnea and paroxysmal nocturnal dyspnea

a) What are the treatment options available and which would you recommend for her?
b) Name recent trial conducted for such intermediate to high risk patients and its result interpretation?
c) What is the reason for low gradient, despite critical aortic stenosis?
d) What is the complication of TAVR?
Answers:
a. Open surgical repair and TAVR, in this patient TAVR is recommended as he is at high surgical risk due to multiple comorbid conditions.
b. SURTAVI Trial
c. Paradoxical low-flow (PLF) aortic stenosis – LV dysfunction secondary to increased afterload imposed by critical aortic stenosis
d. Complications:
- Bleeding
- Hematoma
- Stroke
- CHB requiring PPM insertion
- Para-valvular leakObstruction of coronary ostea
References:
- Chapter 15, page 238 – Aortic valve disease - Manual of Cardiovascular Medicine Fourth Edition - Brian P. Griffin MD FACC
- Reardon MJ, et al. "Surgical or transcatheter aortic-valve replacement in intermediate-risk patients". The New England Journal of Medicine. 2017. epub 2017-03-17:1-11.[PubMed]
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