Abstract
An 81-year-old woman with aortic valve stenosis (3+), aortic valve insufficiency (1+), and coronary artery disease was scheduled for elective aortic valve replacement and coronary bypass surgery. The patient suffered from syncopal episodes and dyspnea at rest. Comorbidities were slight renal insufficiency, diabetes mellitus type IIb, and hyperlipoproteinemia. The patient received oral digitoxin, furosemide, simvastatin, glibenclamide, bisoprolol, and ramipril. Preoperative transesophageal echocardiography (TEE) and transthoracic echocardiography had shown a severely calcified aortic valve (area, 0.7 cm 2 Schuenemann S Andreas S Kreuzer H Werner GS Complete morphologic and functional resolution of endocarditis of a Toronto stentless porcine bioprosthesis: A study by serial transesophageal echocardiography. J Am Soc Echocardiogr. 1998; 11: 77-79 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ), left ventricular hypertrophy (wall thickness, 16 mm), and a transvalvular maximum systolic gradient of 88 mmHg (mean, 54 mmHg). Ejection fraction was 50%. Cardiac catheterization had revealed a 70% stenosis of the left anterior descending coronary artery (LAD).
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