Dr. Rich Heuser’s upcoming Cardiovascular Disease Management: A Case-Based Approach, 3rd Annual Symposium, will take place October 1-2, 2015 at the historic Arizona Biltmore Hotel in Phoenix, Arizona. The following case study will be used for the discussion on Aortic Valve Disease.
In the comments below, let Dr. Heuser know how you would manage this patient:
An 60-year-old healthy male comes to see you with symptomatic aortic stenosis. He has had episodes of congestive heart failure requiring hospitalizations two times over the last month. He has been known to have aortic stenosis by catheterization 3 years ago, with an aortic gradient of 30mm. Now a recent heart catheterization shows an aortic gradient of 60mm gradient and the aortic valve area calculated at 0.8. His coronaries by arteriography are normal. He has no aortic insufficiency. He has no other risk factors or comorbidities. He would prefer not have have a surgical procedure.
For the detailed program, registration, CME, and hotel information for CDM 2015, please visit: http://promedicacme.com/meeting/Cardiovascular-Disease-Management-A-Case-Based-110.html.
out of the question is a TAVI. patient is low risk and relatively young.
i would strongly advise a SAVR, bio or mechanicalprosthesis is up to the patient.
if he still declines surgery, i would not help this patient i.e. i would not give him a TAVI.
The patient needs to be educated as to the natural history of Aortic Valve stenosis. TAVI is not an option such as a hard top vs convertible when car shopping. Perceived convenience should not direct care away from the best short and long term treatment.