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TAVI-Procedure: a Brand New Start for a Patient with Class 3 NYHA Heart Failure

Diyana Kyuchukova, Simona Nikolaeva, Dilyana Tonkova, Cvetomir Yankov, Branimir Kanazirev

Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) is a breakthrough approach for treatment of symptomatic patients with severe aortic stenosis. The procedure is minimally invasive. Risk assessment is mandatory, since TAVI is currently considered only in patients who have a very high surgical risk. Candidates for this procedure must be symptomatic with established severe AS (stage D according to the 2014 AHA/ACC valvular heart disease guidelines) and should have a a life expectancy of more than one year.

Materials and Methods: A 75-year-old woman with a high-grade aortic stenosis and accompanying coronary artery disease class III NYHA, hypertension, chronic total heart failure III grade and atrial fibrillation was admitted at the hospital on January 20, 2017, complaining of breathlessness and fatigue. On physical examination she presented with cyanosis of the fingers, orthopneic position in bed and swelling of the feet. Echocardiography determined that the patient had a 3th grade of mitral, aortic and tricuspidal regurgitation with EF – 48 %, diastolic and systolic dysfunction , thus making her an appropriate patient for a TAVI procedure.

Results: Surprisingly, only a week afterwards, on control echocardiography, the patient presented with improvement in the grade of the mitral, aortic and tricuspidal regurgitation and EF – 70%, making an incredibly fast recovery.

Conclusion: This patient with symptomatic severe aortic valve stenosis and high grade of heart failure NYHA III underwent successful transfemoral TAVI. After the procedure, the patient’s symptoms were markedly improved from NYHA class III to class I. She was discharged without any significant complications and remained free of adverse clinical events after a 6-month follow-up. This case illustrated how remarkable  results after TAVI could be.


Keywords

TAVI, aortic stenosis, heart failure


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