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From Severe Aortic Stenosis to Mitral TEER: Overcoming Surgical AVR Complicated With LVOTO
Tasha M Heller1, Sara Lezcano1, Ram Hirpara1
1Cardiovascular Disease Broward Health Medical Center, Fort Lauderdale, Florida, USA.
Background:
Systolic anterior motion (SAM) and dynamic left ventricular outflow tract obstruction (LVOTO) is a well-described phenomenon in hypertrophic obstructive cardiomyopathy and rarely reported after surgical aortic valve replacement (AVR).
Case Summary:
We present the first reported case of SAM and LVOTO developing intraoperatively after surgical AVR for severe bicuspid aortic valve stenosis necessitating mitral transcatheter edge-to-edge repair (TEER) with the MitraClip. Optimal titration of pharmacologic management was not sufficient to relieve LVOTO in our patient.
Why Beyond The Guidelines:
Despite management following conventional guidelines, the patient remained in critical condition. TEER with the MitraClip led to a reduction in SAM and optimization of his cardiovascular profile.
Discussion:
There is limited literature regarding intervention with TEER on post-AVR patients.
Take-Home Message:
LVOTO can present suddenly, as in our case, necessitating a multispecialty approach to unconventional interventions to stabilize a critically ill patient.
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