Transcatheter Aortic-Valve Replacement.

Case History: A 77-year-old man presents with fatigue and shortness of breath with minimal exertion. He is brought into the examination room in a wheelchair due to shortness of breath with ambulation. He has a history of hypertension, diabetes mellitus, and coronary artery disease with prior stent to left anterior descending artery. Examination is notable for a harsh III/VI late-peaking systolic murmur in the right upper sternal border that radiates to the carotid arteries. EKG shows left ventricular hypertrophy with strain. Laboratory results are notable for serum creatinine of 2.0 mg/dL. Echocardiography is notable for an ejection fraction of 35%, with global hypokinesis in a hypertrophied ventricle. The aortic valve is calcified and stenotic with a peak velocity of 4.2 m/s, a mean gradient of 45 mm Hg, and a calculated aortic valve area of 0.7 cm. Computed tomography scan of the thorax reveals a densely calcified aorta (Figure 1).