Aortic stenosis Quiz

A 72-year-old female is visiting her son from India and complains of chest pain. She is taken to an ER and diagnosed with gastritis. She mentions that she has had several episodes of rectal bleeding in the past two years. A GI work up shows AV malformations. On further questioning she seems to be symptomatic due to her AS. She also reports 4 episodes of syncope in the last 6 months. During workup of chest pain she gets an EKG, which shows severe LVH but no MI. A TTE shows severe aortic stenosis. You are consulted prior to discharge. Best plan of management is to:

A 32 year old female is referred to you for severe symptomatic aortic stenosis. She was told as a child that she had a congenitally abnormal aortic valve. She mentions that she intends to get married next month and wishes to have kids. By her echocardiogram she has severe AS and will need a new aortic valve. Of those listed, which is the most viable options for her:

A 72 year old gentleman from Sierra Leone complains of fatigue and shortness of breath. The SOB is of several years duration. Paradoxical splitting of the second heart sound and a systolic murmur are auscultated. TTE report shows a thickened LV, aortic valve area of 0.9cm2, a pressure gradient of 29mmHg, peak velocity of 3.3m/sec. His LV EF is reported as 38%. You confirm that his symptoms have been getting progressively more severe. He is on aspirin, hydralazine, vitamin D, flomax and synthroid. Next best step in management:

You are seeing 72 year old with shortness of breath at rest in the setting of aortic stenosis. He asks you “how long am I going to live if I do not undergo surgery?” Which of the following is the most appropriate response?

An 82-year-old frail woman presents with severe shortness of breath, chest pain, and several episodes of syncope. A diagnosis of severe aortic stenosis is made. Owing to her multiple co-morbidities, her STS risk is estimated at 14% and she is deemed inoperable. Therefore, a trans-femoral TAVR is planned given her favorable peripheral vasculature. The procedure is commenced with placement of a pacing wire in the femoral vein and a 6F sheath in the right common femoral artery. You begin to gain arterial access into the left groin for placement of dilators and sheath and are unable to pass the wire despite your best efforts. Your best option is:

A 75 year old with severe symptomatic AS presents to your office after a referral for a valve replacement. His other co-morbidities include HTN, HLD, diabetes, rheumatoid arthritis, chronic kidney disease, COPD (on 2L home oxygen). You calculate his STS score as 9%. You elect to perform a TAVR via a trans-femoral approach (26mm Sapien XT). There is no peri-valvular leak at the end of the procedure. A root angiogram in the OR after deployment shows a focal aortic dissection above the right coronary artery. Patient appears well and hemodynamics are normal but the rhythm shows a 2nd degree heart block. Your next course of actions is: