Investigations:
Transthoracic echocardiography (TTE) was significant for severe
bioprosthetic aortic valve stenosis with moderate to severe paravalvular
regurgitation (peak velocity 3.7 m/s, DVI 0.24, acceleration time
> 100ms with mean gradient 35mmHg) (Figure A) .
Left ventricular ejection fraction was 46%. Additionally, pulmonic
valve stenosis was identified with peak/mean gradient of 66/41 mm Hg and
max velocity 4.0 m/s. Angiography demonstrated occluded LIMA to LAD
graft with the native LAD supplied by the native left main, and total
occlusion of the native LCX with patent SVG to the LCx. A right heart
catheterization (RHC) was remarkable for severely elevated right
ventricular systolic pressure of 102 mm Hg (Figure B).Pulmonary artery pressure (PAP) was 32/15 mm Hg with mean PAP of 22 mm
Hg.