Download AF - Belgian Working Group Heart Failure and Cardiac Function

Acute heart failure and
significant aortic valve stenosis
Prof. Dr. W. Van Mieghem
13-09-2008
A.F.
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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 RCA
12/2002
• 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