Case 2
A 75-year-old female presented with a Porcelain Aorta and a
long-standing history of severe, symptomatic aortic insufficiency, with
a severely calcified aorta throughout, a calcium score of 5888, and
diffuse aneurysmal dilation of the ascending aorta. She was deemed
inoperable mostly because of frailty, severe pulmonary hypertension, and
the associated Porcelain Aorta, and therefore consider for a TAVR
procedure. A transthoracic echocardiogram prior to surgery showed
adequate left ventricular systolic function with an ejection fraction of
60%, dilation of the left ventricle, severe aortic insufficiency, and
severe pulmonary artery hypertension with right ventricular systolic
pressure of 80 mmHg (Figure 3). Her aortic area was 452
mm2. The patient had a successful percutaneous right
transfemoral TAVR with Medtronic 29 mm Evolut Pro valve implanted,
followed by an Edwards SAPIEN 3, #26, -1 cc bioprosthetic valve
deployment inside the first valve (Figure 4). At the end of this
procedure, there was trace aortic insufficiency present and excellent
hemostasis confirmed by transesophageal echocardiography.