84 Year Old Woman with
CAD and Aortic Stenosis
84 Year Old Woman with AS
and Low LV Ejection Fraction
Case Presentation
• Underwent CABG surgery 11 years ago
• Non-ST-elevation myocardial infarction one
year ago
• Known aortic stenosis
• Can walk slowly; limited by dyspnea and
fatigue
Fletcher A. Miller, Jr, MD
Mayo Clinic Rochester
• Recent hemoglobin 8.1; received transfusions
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84 Year Old Woman with
CAD and Aortic Stenosis
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84 Year Old Woman with
CAD and Aortic Stenosis
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84 Year Old Woman with
CAD and Aortic Stenosis
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84 Year Old Woman with
CAD and Aortic Stenosis
LVOT TVI 15 cm
LVOT Diameter
2.1 cm
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HR
SV
SVI
CI
64/min
52 cc
31 cc/m2
2.1 L/min/m2
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84 Year Old Woman with
CAD and Aortic Stenosis
AV MG 39 mmHg
AV TVI 97cm
SV 52cc
AVA 0.54 cm2
84 Year Old Woman with
CAD and Aortic Stenosis
Aortic Valve CW Doppler
Apex
Right Parasternal
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84 Year Old Woman with
CAD and Aortic Stenosis
84 Year Old Woman with
CAD and Aortic Stenosis
Mitral Valve PW Doppler
E = 1.1 m/sec
A = 0.9 m/sec
E at A = 0.3 m/sec
Corrected A = 0.6 m/sec
E/A = 1.8
DT = 138 msec
Grade 3-4/4 Diastolic Dysfunction
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84 Year Old Woman with
CAD and Aortic Stenosis
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84 Year Old Woman with
CAD and Aortic Stenosis
Tricuspid Valve CW Doppler
Normal Caliber Ascending Aorta
TR velocity
3.3 m/sec
RVSP
58 mmHg
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84 Year Old Woman with
CAD and Aortic Stenosis
84 Year Old Woman with
CAD and Aortic Stenosis
Echo Report
• Severe calcific aortic stenosis with mild regurgitation
• AVA 0.54 cm2; MG 39 mmHg
• Moderately calcified mitral annulus with thickened
leaflts, mild stenosis and mild to moderate regurgitation
•
•
•
•
• Because of comorbidities, including dementia,
it was decide not to proceed wth aortic valve
replacement
• She received palliative care
Borderline LV enlargement with EF 19%
LV SVI 31 cc/m2; CI 2.1 L/min.m2
Grade 3-4/4 LV diastolic dysfunction
RVSP 58 mmHg (BP 96/60 mmHg)
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Mayo Clinic
Locations
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