AVR for AS with Moderate MR
View archiveTEEintraoppreopME4CV2D
Short case presentation
78 y.o. with a history of SOB, DOE, and CP.
The patient has had a CABG, pacemaker/defibrillator and Left TSA.
The patient has COPD, Renal Insufficiency, and RA.
The patient has a history of CHF, HTN, Afib
The patient is on ACE-I, Beta Blockers, Diuretics, ASA and Coumadin
A cardiac cath showed:
LIMA -> OM patent
RIMA -> LAD patient (croses midline)
SVG -> RCA occluded
An echo showed Severe AS (AVA 0.84 cm2), Moderate MR, LVEF 30%
Questions to consider are:
What is your interpretation of the TEE, sepcifically the AS and MR severity?
Why does the AVG not correlate with the AS severity?
How does anesthesia affect the AVA calculations compared to preop echo exams?
How does a Surgical AVR (SAVR) affect the postoperative MR?
Does a Transcutaneous Aortic Valve Implantation (TAVI) offer any advantages for postoperative MR over SAVR?
What factors determine if the MR will improve or worsen?
The patient has had a CABG, pacemaker/defibrillator and Left TSA.
The patient has COPD, Renal Insufficiency, and RA.
The patient has a history of CHF, HTN, Afib
The patient is on ACE-I, Beta Blockers, Diuretics, ASA and Coumadin
A cardiac cath showed:
LIMA -> OM patent
RIMA -> LAD patient (croses midline)
SVG -> RCA occluded
An echo showed Severe AS (AVA 0.84 cm2), Moderate MR, LVEF 30%
Questions to consider are:
What is your interpretation of the TEE, sepcifically the AS and MR severity?
Why does the AVG not correlate with the AS severity?
How does anesthesia affect the AVA calculations compared to preop echo exams?
How does a Surgical AVR (SAVR) affect the postoperative MR?
Does a Transcutaneous Aortic Valve Implantation (TAVI) offer any advantages for postoperative MR over SAVR?
What factors determine if the MR will improve or worsen?
