Critical decompensated aortic stenosis – a cascading approach to treatment

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simpozij Radne skupine za bolesti srčanih zalistaka Hrvatskog kardiološkog društva s međunarodnim sudjelovanjem "Aortna stenoza" 3 th Symposium of the Working Group on Valvular Diseases of the Croatian Cardiac Society with international participation "Aortic Stenosis"91 -year-old patient was admitted with symptoms and signs of heart failure.Transthoracic echocardiography (Figure 1) revaled severe aortic stenosis (max gradient 122 mmHg, mean 62 mmHg, AVA 0.4-0.5 cm 2 ), moderate-severe mitral and tricuspid regurgitation, reduced left ventricular systolic function (LVEF 30%) and high pulmonary hypertension (PAP 90-95 mmHg).Coronary angiography showed no significant coronary artery disease.Due to age and poor functional status (NYHA IIIB / IV), aortic valve surgery was estimated as high risk, and it was decided to perform transcatheter aortic valve implantation (TAVI).Patient was presented to TAVI Heart Team.Meanwhile, the patient underwent successful balloon aortic valvuloplasty (BAV), with a consequent drop in the max gradient between the left ventricle and the aorta from 91 to 52 mmHg, without significant aortic regurgitation.After BAV and intensive diuretic therapy, left ventricle volume unloading and functional recovery was accomplished.Six months later, the patient underwent successful transfemoral TAVI (CoreValve 26).Control echocardiography (Figure 2) revealed the recovery of left ventricular systolic function (LVEF 50-55%) with normal function of the CoreValve (max gradient 24 mmHg, mean 10 mmHg), moderate mitral and tricuspid regurgitation and some reduction of pressures in the pulmonary circulation (PAP 45 mmHg).The patient was discharged on the 7 th post-interventional day, mobilized, in NYHA II functional status.

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