ABSTRACT
Case presentation • Percutaneous aortic balloon valvuloplasty • Percutaneous aortic valve replacement • Future directions
CASE PRESENTATION
An 87-year-old female was admitted with recurrent congestive heart failure. She was known to have long-standing severe aortic stenosis (valve area 0.53 cm2) and coronary artery disease with a left ventricular ejection fraction of 50%. After she was stabilized, the patient was taken to the cardiac catheterization laboratory. Coronary angiography revealed osteal left main coronary stenosis and osteal right coronary stenosis. She refused surgical intervention. High-risk percutaneous coronary intervention was offered. The patient was placed on a TandemHeart percutaneous left ventricular assist device (left atrial to femoral artery bypass), and the left main coronary artery was stented with a Cypher drug-eluting stent (Figure 18.1(a) and (b)). The osteal right coronary artery was then also stented with a Cypher drug-eluting stent (Figure 18.1(c) and (d)). Aortic valvuloplasty was performed using a 20 mm valvuloplasty balloon using the assist device to maintain flow while minimizing balloon movement. The resultant valve area was increased to 0.8 cm2 The assist device was removed in the catheterization laboratory. At last follow-up (11 months after procedure), the patient was doing well at home without recurrent heart failure symptoms.
Aortic valve stenosis is the most common acquired form of cardiac valvular disease. Though rheumatic etiologies continue to constitute a fair proportion of aortic stenosis, their incidence is declining.1 Senile calcific aortic valve disease, either stenosis, regurgitation, or mixed disease, represents the most common form of aortic valve disease today, occurring in up to 2.9% of patients over 65 years old.2
