78 year old gentleman with severe Aortic Stenosis and normal LV systolic function. Given his age and frailty, he was deemed to high risk by the surgeons for aortic valve replacement. Work up including TEE, CT and coronary angiogram revealed that he is a good candidate for TAVI via femoral access. The procedure was performed successfully using an Edwards Sapien Valve through the transfemoral approach. No complications occurred. Post procedure TEE (3D) confirmed excellent valve position and function.
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70 year old gentleman with recent TIA and a history of CABG 9 years ago. Work up revealed and LVEF of 35% and significant Internal Carotid Artery stenosis by MRA. He was assessed by the neurologists and vascular surgeons. After a lengthy discussion with the patient and his family, he was deemed high risk for carotid endarterectomy. Therefore, carotid artery stenting was performed using the Accunet 7 distal protection device and Acculink 8-10 self expanding stent. The procedure was successful and no neurological complications occurred. He continues to follow up in the outpatient clinic.
This is a 67 year old gentleman who was admitted with a NSTEMI. He also suffers from COPD. His echocardiogram showed a depressed LV systolic function and wall motion abnormalities in the LAD territory. A diagnostic coronary angiogram revealed a heavily calcified LAD. The option of CABG vs high risk PCI with rotoblation and Impella 2.5 circulatory support system was discussed with the patient, his family and the surgeons. There was a consensus agreement to proceed with PCI. An Impella 2.5 circulatory support device was inserted through the left common femoral artery through a 13 French sheath. The LAD intervention was performed through the right common femoral artery. The vessel was rotoblated with a 1.75 burr. He remained hemodynamically stable throughout the procedure. Then 3.0 everolimus drug eluting stents were successfully deployed and TIMI III flow obtained. The left common femoral arteriotomy was closed using Perclose and the right using Starclose.
19 year old female with coarctation of the aorta confirmed by cardiac MRA. An Advanta V12 Atrium stent was successfully deployed and postdilated. The procedure was uncomplicated. She returned for a follow up angiogram after 6 months which showed no significant residual gradient or restenosis.