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Acute heart failure and significant aortic valve stenosis

Acute heart failure and significant aortic valve stenosis. Prof. Dr. W. Van Mieghem 13-09-2008. A.F. 75 year old male patient Antracosilicosis Arterial hypertension Type II diabetes mellitus Cigarette smoker

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Acute heart failure and significant aortic valve stenosis

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  1. Acute heart failure and significant aortic valve stenosis Prof. Dr. W. Van Mieghem 13-09-2008

  2. A.F. • 75 year old male patient • Antracosilicosis • Arterial hypertension • Type II diabetes mellitus • Cigarette smoker • Peripheral vascular disease with bypass surgery right femoral artery and amputation first toe left foot

  3. A.F. • Coronary artery disease • Myocardial infarction 11/2002 • CABG: critical main stem stenosis stenosis RCA 12/2002 • Degenerative aortic stenosis • Heart failure 5/2003 • New onset angina pectoris 12/2007

  4. Acute HF hospitalization 13/08/2008 • Raised jugular venous pressure • Pulmonary oedema • Aortic valve stenosis

  5. Coronary arteriography • LIMA -> LAD: normal function • RIMA -> RCA: normal function • SVG -> CX: normal function

  6. Pulmonary function • FVC 1,43 l= 40% normal value • FEV1 1,41 l= 60% normal value • R.V. 0,96 l= 38% normal value • TLC 2,3 l= 41% normal value

  7. Duplex carotid arteries • 90% stenosis RCA

  8. How to treat this patient?

  9. Cardiac MRI • The myocardium is thinned at the apical level with a diffuse delayed enhancement and moderately dyskinetic movement during the ventricular contraction • Fibrotic and non-viable tissue

  10. Proposed treatment • Right carotid endarterectomie • Aortic valve replacement • Aneurysmectomie

  11. Operation: • Succesfull right carotid endarterectomie • Extremely difficult dissection because of extensive pericardiac fibrosis with massive adhesions • Aortic valve replacement with bioprothesis • Aneurysmectomie not performed because of technical difficulties • The postoperative cause was complicated with a right sided pneumonia and the patient remained on the respirator for 30 days • Patient is still mentally recovering

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