Dr. Usman's Cardiology Notes

This is going to be a quite a long presentation. essentially focusing on the interventions and surgery and how Echo plays a major role in these situations when you look at the Echo in terms of trans thoracic, there's always this restriction because it is a caged organ. it is inside. And then it is surrounded by the lungs on either side and this has a problem in terms of good imaging and this can be a problem many times when it comes to interventions or surgery when either in the assessment or in the during the procedural or even post operative you always been a dependent and you're always used the traditional tools of two color doctor and the spectrum doctor and over a period of time, this has been the foundation now for all. As far as echoes in addition to that. has given additional support and provided incremental. information and in terms of the help it can provide when the interventions are being done. now wi...

Transcatheter Aortic Valve implantation for aortic stenosis in patients who cannot undergo surgery - The New England Journal of Medicine - 2010 Brief Summary: In patients with severe AS who are poor surgical candidates, transcatheter aortic-valve implantation reduces all-cause mortality and rates of rehospitalization for valve or procedure-related deterioration when compared to standard therapy, at the expense of more strokes. Reference: http://www.ncbi.nlm.nih.gov/pubmed/20961243

Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients - The New England Journal of Medicine - 2011 Brief Summary: In patients with symptomatic severe AS who are high-risk surgical candidates (expected peri - procedural mortality ~ 15%), TAVI was associated with similar all-cause mortality to surgical AVR at 1 year. Reference: http://www.ncbi.nlm.nih.gov/pubmed/21639811

Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients - The New England Journal of Medicine - 2016 Brief Summary: In patients with symptomatic severe AS who are intermediate-risk surgical candidates (expected periprocedural mortality ~ 4-8%), TAVI was noninferior to surgical AVR with respect to all-cause mortality and disabling stroke at 2 years. Reference: http://www.ncbi.nlm.nih.gov/pubmed/27040324

Surgical or Transcatheter Aortic-valve replacement in intermediate-risk patients - The New England Journal of Medicine - 2017 Brief Summary: In patients with severe, symptomatic AS at intermediate surgical risk (3-15% risk of surgical death at 30 days per STS-PROM score), transcatheter aortic valve replacement (TAVR) was found to be non-inferior to surgical aortic valve replacement (SAVR) with respect to all-cause mortality and disabling stroke at 2 years. SAVR was associated with a marginally higher peri-operative stroke rate while TAVR was associated with a modest increase in hospitalizations related to aortic valvular disease at 2 years. Reference: http://www.ncbi.nlm.nih.gov/pubmed/28304219

Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients - The New England Journal of Medicine – 2019 Brief Summary: In patients with symptomatic, severe aortic stenosis who are low-risk surgical candidates, TAVR was associated with a 6.6% absolute reduction in death, stroke, or re-hospitalization at 1 year when compared to SAVR. The superiority of TAVR was driven by symmetric reductions in each component of the primary endpoint, including a 1.5% absolute reduction in overall mortality. Reference: http://www.ncbi.nlm.nih.gov/pubmed/30883058

A 78 year old female, diabetic, overweight and hypertensive presented with severe shortness of breath, orthopnea and paroxysmal nocturnal dyspnea. She has limited mobility at home due to easy fatigue. On examination she was restless , tachycardiac with heart rate of 130 beats per minute, respiratory rate of 26 per minute and Blood Pressure of 110/60 mmHg. Auscultation revealed ejection systolic murmur at upper sternal border radiating to neck, S 3 gallop and a displaced PMI on palpation. There were bilateral crackles in the chest. ECG showed ST depression in anterior precordial leads. Labs revealed a Troponin of 170, Creatinine of 2.0 mg/dl and BNP of 1617. Chest X-Ray revealed pulmonary edema. Echocardiography revealed EF of 35%, global hypokinesia, Aortic Valve Area of 0.8cm 2 and a mean gradient of 28 mmHg. a) What are the treatment options available and which would you recommend for her? b) Name recent trial conducted for such intermediate to high risk patients and its result inter...