Introduction: Aortic stenosis is now one of the most common valvular heart disease. In inoperable patients or with very high risk with symptomatic severe aortic stenosis, transcatheter aortic valve implantation (TAVI) has proved its benefit over medical therapy or conventional surgical treatment. The European Society of Cardiology mentions recently that even in patients at intermediate risk, TAVI is at least as beneficial as surgical intervention.
Case presentation: We present a case of a 78 year-old man who presented to a local hospital for mild dyspnea and retrosternal pain at mild effort and rest, worsened in the last month. The patient was diagnosed with severe degenerative aortic stenosis and referred to our hospital for further investigations. He was known with chronic lung disease, type II diabetes and mild chronic kidney disease. Electrocardiographic he presented grade I atrioventricular block, with left ventricular hypertrophy criteria, without ischemic changes. The 2D echocardiography at admission confirmed severe aortic stenosis (medium gradient of 55 mmHg, peak systolic flow of 5,2 m/s) and moderate aortic insuffici-ency with mild mitral insufficiency and preserved left ventricle ejection fraction. In order to decide further therapeutic strategy we performed coronary angiography which showed coronary arteries with no signifi-cant stenosis. The EUROSCORE II was calculated at a value of 3,5%, but the patient refused open surgery. Under these circumstances the heart team decided to perform a transcatheter aortic valve replacement (TAVI) with femoral approach. A multislice computed tomography (CT) was also performed, indicating aortic annulus dimensions of 26 mm. Under oro-tracheal intubation, mechanical ventilation and transesopha-geal echocardiography an implantation of a biological aortic prosthesis Edwards Sapien 3 no 26 was perfor-med, with excellent final result and no paraprosthetic or intraprosthetic leak. Intraprocedural the patient pre-sented ventricular fibrillation, rapidly resuscitated, and transitory complete left bundle block. Post procedural echocardiography showed peak systolic aortic flow of 2,5 m/s and a mean gradient of 20 mmHg, with a mini-mum paraprosthetic leak. Before discharge, the patient was also evaluated by 24 hours electric monitoring with no sustained tachyarrhythmia or pathological pauses. At 2 months evaluation, the patient was asymptomatic, with normal function of the aortic prosthesis.
Case particularities: T his case highlights the impor-tance of a proper diagnosis and evaluation of a patient with severe aortic stenosis in order to an adequate the-rapeutic approach. Although a non complicated case of TAVI it shows the important medical, socio-economic and psychological impact.
Conclusions: Transcatheter aortic valve implantation (TAVI) is a highly effective procedure in selected patients with severe degenerative aortic stenosis at inter-mediate or high risk for conventional surgery.