Complex LAD CTO - Mitral Valve in Valve - Simultaneous TAVI and septal alcohol ablation cases

CASE 01: Complex LAD CTO  -Dr.Paul Hsien Kao Li - Dr.Marco Wainstein

Strategy Plan

Imaging studies

• Coronary angiography: patent RCA , ostial LAD CTO , JCTO Score :3
• Echo:  LV EF  53%
• Nuclear testing :postive ischemia and viability 

Clinical indication

• Exertional anginal III CCS and positive viability

Planned Procedure

• Bilateral 8F Femoral access and Retrograde first strategy

CASE 02: Transfemoral Mitral Valve-in-Valve procedure    -Dr.George NICKENIG- Dr.Nikos WERNER

Strategy Plan

Imaging studies

• Coronary angiography: patent Grafts
• Echo:  LV EF  71%, severe mitral regurgitation (leaflet flail ) PISA:2.1 cm², sPAP:44mmhg
• CT Scann:CE SAV 29mm , Area 430mm²

Clinical indication

• Symptomatic severe mitral regurgitation and comorbidities Log EUROSCORE:10.79%; STS SCORE: 4.97%)
• Heart Team Decision

Planned Procedure

• Tranfemoral Mitral ViV with Edwards Sapien 3 29mm

CASE 03: TAVI in patient with severe septal hypertrophy -Dr.Eberhard GRUBE

Strategy Plan

Imaging studies

• Coronary angiography:Two vessels CAD  
• Echo:  LV EF  69%, severe Aortic stenosis: Vmax 3.5m/s, Low dose Dobu: 8m/s , septal Hypertrophy with dynamic obstruction
• CT Scann:Area 341.7mm²    Perimeter 68mm

Clinical indication

• Symptomatic severe  Aortic stenosis with dynamic and comorbidities (Log EUROSCORE:20.94%; STS SCORE: 7.82%)
• Heart Team Decision

Planned Procedure

• Tranfemoral TAVI with  26mm Evolut PRO