Aortic stenosis – from a challenging diagnosis to a non-routine therapy

█ Case report

DOI: 10.26430/CHUNGARICA.2023.53.1.43

Authors:
Andréka Judit¹, Gulyás Zalán², Székely László², Kiss Róbert Gábor², Duray Gábor², Kerecsen Gábor^2
1Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ, Belgyógyászati Klinika, Déli Telephely, Invazív Kardiológiai Részleg, Szeged*
²Észak-Pesti Centrumkórház, Honvédkórház, Budapest

Levelezési cím:
Dr. Andréka Judit, e-mail: andreka.judit@gmail.com

Summary

Aortic stenosis is a condition that is significantly limiting the quality of life that is becoming more common today due to the aging of the population. Today, there are a number of methods available for both diagnosing the disease and providing definitive care.
A 88 year old heart failure patient with reduced ejection fraction has a history of previous percutaneous coronary intervention (PCI) and several hospitalizations for cardiac decompensation in 2021. In the background with transthoracic echocardiography (TTE) low-flow low-grade aortic stenosis had been diagnosed, repeated coronarography confirmed two branch disease. In connection with the assessment of the significance of the aortic vitium, dobutamine stress echocardiography (DBSE) was performed, on the basis of which true severe aortic stenosis was reviewed and referred to our institute for further therapy. With CT scan of the valve we measured Ca score and with invasive hemodynamic measurement we determined the aortic valve area according to Gorlin. In combination with invasive intervention, coronary heart disease was revascularized. In view of the high risk of surgery, transcatheter aortic valve (TAVI) implantation was planned. Due to the severe calcification of the aortic ascendant and descendant and aorto-iliac continuum described in CT we opted for transapical penetration. Following repeated cardiac decompensation in December 2021, the procedure was performed urgently and successfully.

ISSUE: CARDIOLOGIA HUNGARICA | 2023 | VOLUME 53, ISSUE 1

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