DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Aortic stenosis.
POSTOPERATIVE DIAGNOSIS: Aortic stenosis.
PROCEDURE PERFORMED: Transesophageal echo with Doppler flow imaging, contrast echocardiogram, and conscious sedation, as well as 3-dimensional imaging.
DESCRIPTION OF PROCEDURE: After obtaining informed consent, the patient was brought to the catheterization laboratory where his throat was sprayed with lidocaine spray. He was sedated with a total of 3 mg of Versed and 50 mcg of fentanyl while being constantly monitored by the nurses for heart rate, blood pressure, oxygen saturation, and cardiac rhythm. A transesophageal echo probe was passed to the level of the left atrium, and imaging was done in multiple projections. At one point, the agitated saline was injected for contrast effect. The probe was passed to the stomach for transgastric imaging. Upon removal of the probe, the thoracic aorta was imaged. The patient tolerated the procedure well. There were no apparent complications.
PROCEDURE FINDINGS:
The left atrium was mildly enlarged. There was no mass or thrombus seen in the left atrium or its appendage.
The left ventricle was hypertrophied with normal systolic function. There were no obvious wall motion abnormalities.
The mitral valve leaflets were thickened. There was minimal mitral regurgitation by Doppler echocardiogram.
The aortic valve was trileaflet and the opening was reduced consistent with significant aortic stenosis. It was not very heavily calcified. There was trivial aortic insufficiency. The measurements at the aortic annulus showed a diameter of 29 mm. Two different measurements of the area were 694 and 784.
The sinotubular junction was 23 mm. The sinus of Valsalva was 37 mm.
Right-sided cardiac structures, including the pulmonic and tricuspid valve, were normal. There was mild tricuspid regurgitation.
The interatrial septum was intact. There was no evidence of shunt by either contrast or Doppler echocardiogram.
There was no pericardial effusion.
The thoracic aorta showed mild plaquing but no high-risk protruding atheroma.
IMPRESSION:
1. Severe aortic stenosis. The annulus appears to be too large for the current technology of transcatheter aortic valve replacements.
2. Left ventricular hypertrophy with normal systolic function.
