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

Acute heart failure and significant aortic valve stenosis

Prof. Dr. W. Van Mieghem13-09-2008

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

A.F.

• Coronary artery disease• Myocardial infarction 11/2002• CABG: critical main stem stenosis

stenosis RCA12/2002

• Degenerative aortic stenosis• Heart failure 5/2003• New onset angina pectoris 12/2007

Acute HF hospitalization 13/08/2008

• Raised jugular venous pressure

• Pulmonary oedema

• Aortic valve stenosis

Coronary arteriography

• LIMA -> LAD: normal function

• RIMA -> RCA: normal function

• SVG -> CX: normal function

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

Duplex carotid arteries

• 90% stenosis RCA

How to treat this patient?

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

Proposed treatment

• Right carotid endarterectomie

• Aortic valve replacement

• Aneurysmectomie

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