Transcatheter Aortic Valve Replacement in a morbidly obese patient with critical aortic stenosis

A 73 -year-old male morbidly obese patient (class III obesity) with BMI of 44 from Dubai, with history of Type 2 diabetes mellitus, hypertension and depression complained of dyspnea on exertion and had great difficulty in walking even few steps without being breathless.

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He was admitted in a hospital in Dubai for heart failure and later shifted to Lilavati Hospital, Mumbai within a span of 8 days.

Transthoracic echocardiogram (TTE) demonstrated a severely stenosed tricuspid aortic valve. The peak and mean gradient across the valve was 78/48 mm of Hg.

In light of the TTE finding of critical aortic stenosis, Computer tomography (CT scan) as per TAVI protocol and CT coronary angiogram (CTCA) was chosen as the first line investigation with the plan being that the patient would undergo an invasive coronary angiogram if obstructive coronary artery disease was found. The CTCA excluded the presence of significant obstructive coronary artery disease while the TAVI CT confirmed presence of severely calcified aortic valve and that the iliofemoral vessels were suitable for transfemoral Transcatheter Aortic Valve Replacement (TAVR).