Transcatheter Aortic Valve Replacement (TAVR) and Angioplasty in a High-Risk Patient
The profile of patients evaluated daily has gradually presented comorbidities in greater number and complexity to be compensated. Thus, the percentage of patients with high surgical risk is challenging professionals, in addition to the emergence of new technologies, which require professional updating and intensive studies of its risk-benefit reserved for each patient. ZVB, 60 years old, with hypertension, type II diabetes, and severe COPD, was admitted for advanced valve disease and coronary and peripheral arterial disease, with a high functional class and repercussions on echocardiographic parameters (low ejection fraction and elevated gradients and dimensions of the cardiac chambers). The discussion of this case will assess the possible causes involved in the symptoms, the clinical compensation and surgical approach with the greatest benefits to the patient at the time, as well as conducting the follow-up that should be conducted. Having performed transcatheter aortic valve replacement (TAVR) and anterior descending coronary angioplasty, it is necessary to evaluate better surgical access, trans- and postoperative hemodynamic management, and valvar echocardiographic control and ensure patient compliance to cardiovascular and implanted device protection medications as well as control of basic pathologies. Patient had no new symptoms, and the control echocardiograms showed a well-positioned prosthesis free of dense echoes inside, without paravalvular regurgitation. After 1 year, the patient reports ability to walk up three blocks without symptoms (NYHA II), although the lung condition being an important confusing factor for this assessment.
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