Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures
A 45-year-old male with a history of hypertension since eight years on tablet Amlodipine 10 mg once a day presented to Department of Medicine with complaints of exertional breathlessness. He reported experiencing NYHA grade 3 symptoms for the past two months, dizziness for one month, and an episode...
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JCDR Research and Publications Private Limited
2025-04-01
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| author | Hussein Harb Sourya Acharya |
| author_facet | Hussein Harb Sourya Acharya |
| author_sort | Hussein Harb |
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| description | A 45-year-old male with a history of hypertension since eight years on tablet Amlodipine 10 mg once a day presented to Department of Medicine with complaints of exertional breathlessness. He reported experiencing NYHA grade 3 symptoms for the past two months, dizziness for one month, and an episode of syncope five days ago. Upon admission to the medical ward, a transthoracic echocardiogram was conducted, which revealed aortic jet velocity (Vmax) of 4.8 m/s, mean aortic Pressure Gradient (PG) of 45 mmHg, LV mass index (LVMi) 128 gm/m2, and aortic valve area of 0.7 cm2 suggesting severe aortic stenosis. Pressure curves prior to Transcatheter Aortic Valve Replacement (TAVR) procedure were measured via two 6-French “pigtail” catheters from Cordis. Catheters were inserted through the stenotic valve to the left ventricle via a vascular access point assigned for the transcatheter heart valve. A second catheter was inserted to the aortic root through a second vascular access point. Both catheters were then connected and measured by a pressure line and transducer. Following careful calibration of the pressure transducer, Left Ventricular (LV) and ascending aortic pressures were recorded concurrently across multiple heartbeats. Left heart catheterisation demonstrated a higher LV pressure compared to aortic pressure [Table/Fig-1]. The patient subsequently underwent TAVR with fluoroscopic procedural imaging [Table/Fig-2]. Post-procedurally, left heart catheterisation showed alignment of LV and aortic pressures [Table/Fig-3]. On follow up, after 30 days, the patient’s dyspnoea had significantly improved and the 2-D echocardiography revealed a decreasing LVMi to 115 gm/m2. |
| format | Article |
| id | doaj-art-b40a95484d354834b67c7a1dddca0db4 |
| institution | Kabale University |
| issn | 2249-782X 0973-709X |
| language | English |
| publishDate | 2025-04-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj-art-b40a95484d354834b67c7a1dddca0db42025-08-20T03:53:23ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2025-04-01194OL01OL0210.7860/JCDR/2024/70165.20904Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of PressuresHussein Harb0Sourya Acharya1Resident, Department of Internal Medicine, Ross University, School of Medicine, Miramar, Florida, USA.Professor and Head, Department of Internal Medicine, Datta Meghe Institute of Higher Education and Research, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India.A 45-year-old male with a history of hypertension since eight years on tablet Amlodipine 10 mg once a day presented to Department of Medicine with complaints of exertional breathlessness. He reported experiencing NYHA grade 3 symptoms for the past two months, dizziness for one month, and an episode of syncope five days ago. Upon admission to the medical ward, a transthoracic echocardiogram was conducted, which revealed aortic jet velocity (Vmax) of 4.8 m/s, mean aortic Pressure Gradient (PG) of 45 mmHg, LV mass index (LVMi) 128 gm/m2, and aortic valve area of 0.7 cm2 suggesting severe aortic stenosis. Pressure curves prior to Transcatheter Aortic Valve Replacement (TAVR) procedure were measured via two 6-French “pigtail” catheters from Cordis. Catheters were inserted through the stenotic valve to the left ventricle via a vascular access point assigned for the transcatheter heart valve. A second catheter was inserted to the aortic root through a second vascular access point. Both catheters were then connected and measured by a pressure line and transducer. Following careful calibration of the pressure transducer, Left Ventricular (LV) and ascending aortic pressures were recorded concurrently across multiple heartbeats. Left heart catheterisation demonstrated a higher LV pressure compared to aortic pressure [Table/Fig-1]. The patient subsequently underwent TAVR with fluoroscopic procedural imaging [Table/Fig-2]. Post-procedurally, left heart catheterisation showed alignment of LV and aortic pressures [Table/Fig-3]. On follow up, after 30 days, the patient’s dyspnoea had significantly improved and the 2-D echocardiography revealed a decreasing LVMi to 115 gm/m2.https://jcdr.net/articles/PDF/20904/70165_CE[Ra1]_F(IS)_PF1(AP_OM)_PFA(KM)_PN(IS).pdfgradienthypertensionleft ventricle |
| spellingShingle | Hussein Harb Sourya Acharya Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures Journal of Clinical and Diagnostic Research gradient hypertension left ventricle |
| title | Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures |
| title_full | Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures |
| title_fullStr | Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures |
| title_full_unstemmed | Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures |
| title_short | Prognostic Significance of Transcatheter Aortic Valve Replacement in Aortic Stenosis: The Play of Pressures |
| title_sort | prognostic significance of transcatheter aortic valve replacement in aortic stenosis the play of pressures |
| topic | gradient hypertension left ventricle |
| url | https://jcdr.net/articles/PDF/20904/70165_CE[Ra1]_F(IS)_PF1(AP_OM)_PFA(KM)_PN(IS).pdf |
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