A 77-year-old male patient with a history of dyspnoea of exertion NYHA-||| since 1 month which is worsened to class IV since 15 days. On 10th march he was hospitalized in Abu Dhabi’s Rashid hospital where he was diagnosed as severe Aortic Valve Stenosis.

On Examination
Vitals Stable
CVS – EFM Systolic Murmur

Management/ Progress in Hospital
On 10/04/2019 he underwent TAVI (Trancatheter Aortic Valve Implantation) under local Anaesthisia + Sedation by Dr. Hamdulay and his team through right femorial artery.
23 Size MyVal, pericardial biopropthes aortic valve implanted across the aortic valve.
Post procedure was shifted to ICU with stable Haemodynamic for observation.
Post procedure ECG sinus rhythm no ST-T changes.
After 24hrs left femorial sheaths removed.
He was mobilised out of the bed.
Beta Blockers with held in view of Borderline Bradycardia.
Post Procedure Echo Screening.

Investigation
Pre-Operative
2D-Echo – Gross Concentric LVH. All chambers normal size. Mild and distal septum mildly hypokinetic. Heavily calcified Aortic valve with reduced opening with peak by mean gradient of 86/53 mm of Hg suggestive of Severe AS with Grade ¼ AR. Grade ¼ MR, Grade ¼ AR. No evidence of PR/TR. No significant gradient across LVOT/RVOT.
Normal LVEF – 61%
Post- Operative
2D-ECHO- Normal LV systolic function. k/c/o degenerative Severe AS , s/p TAVI with normally functioning of Aortic valve with Mild MR. Mild Concentric LVH. All chambers normal size.
Bioprosthetic Aortic valve in situ, opening well. No e/o paravalvular leak.
Grade I MR. No evidence of AR/PR/TR. Peak by mean gradient across Aortic valve is 28/16 mm of Hg. AVA by continuity is 1.43 sq.cm.
LVEF 65%.

Operative Notes

Right femorial and left femorial artery venous puntured
Left femorial side 6-F sheath introduced in both venous and artery
Right common femorial artery 10-F sheath introduced
23 size balloon used for commissurectomy and inflated for 3 seconds
Ventricle with pacing at 180 beats/min gradiant aortic valve – nil
Following commissurectomy 23 size MyVal pericardial, bioprothes crimpel introduced and implanted across aortic valve with ventricular pacing of 180 beats/min

Result – Valve position intra-annular

No para valvular leak
Good result
Right femorial cannulation closed with proglide
2 proglide used
Good heamostasis
Patient tolerated procedure well