Severe degenerative aortic stenosis – therapeutical difficulties

Introduction: Valvular degenerative pathology is an important cause of valvulopathy in industrialized countries, with valvular aortic stenosis becoming the most common valvulopathy. In the natural evolution of the disease, the emergence of symptomatology is a decisive moment, associated with an impressive reduc-tion in life expectancy, and is the indication of valvular replacement. The ability of modern medicine to treat, cure and prolong life is so advanced that it seems in-conceivable an end without interventional procedures, regardless of the damage they can produce.

Methods: We present the case of a 76-year-old diabetic patient aged 35 years at the stage of chronic micro- and macrovascular complications with coronary lesions in the right coronary artery (without revascularization) diagnosed with degenerative aortic disease with steno-sis predominance at 75 years of age, with aortic valve aortic chirurgical indication, but considering the high surgical risk, it opts for the transcatheter implantation of the aortic valve, the patient temporizing the interve-ning technique, which is in a serious general situation in the context of decompensation global cardiac.

Results: The investigations performed are aimed at the dilated cardiomyopathy aspect with moderate left ven-tricular systolic dysfunction (LVEF 35-40%), the right ventricle with severely depressed overall systolic func-tion and severe tricuspid regurgitation (undervalued by right ventricular dysfunction). A transcatheter aor-tic valve prosthesis surgery was performed, the patient requiring postoperative positive inotropic support and prolonged vasoactive support. Postprocedural installs intermittent atrioventricular block, for which tempo-rary cardio stimulation was performed. The clinical development is striking by cardiogenic cardiac tampo-nade, requiring emergency pericardiocentesis. It also develops repetitive episodes of upper gastrointestinal bleeding with melena, establishing volley rebalancing and blood supply.

Conclusions: T he development of the interventional technique of transcatheter implantation of the aortic valve requires the presence of a multidisciplinary team. The patient’s right to health is based on his / her state of well-being or health care which is judged by professio-nals with adequate expertise. The principles of medical ethics, the limits of medical science, the cultural and religious belief of patients and their families, as well as medical staff, influence the therapeutic decision.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)