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Complex Cardiac Case Management: Aortic Valve Stenosis and Heart Failure

Prof. Dr. W. Van Mieghem treated a 75-year-old male patient with acute heart failure, aortic valve stenosis, coronary artery disease, and other comorbidities. The patient underwent successful carotid endarterectomy and aortic valve replacement. However, postoperative complications included pneumonia, requiring prolonged respiratory support. The patient is undergoing mental recovery post-surgery.

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Complex Cardiac Case Management: Aortic Valve Stenosis and Heart Failure

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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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