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Case Sharing: A Case of Severe Aortic Stenosis with Shock and Multiple Organ Failure Treated with BAV in the Acute Phase and TAVI in the Secondary Phase

Dr. Shinnosuke Kikuchi, Yokohama City University Medical Center

Case

Male in his 80s

Chief complaint

Dyspnea

Medical history

Aortic stenosis,

Hypertension,

Diabetes mellitus,

Dyslipidemia,

Cervical spondylosis,

Cataract

Medication history

Amlodipine besylate tablets 5mg,

Sitagliptin phosphate tablets 25mg,

Pioglitazone 15mg,

Pitavastatin calcium 1mg

Family history

No records of the illnesses above

Preference history

Smoking

Alcohol consumption: None

Current medical history

Severe aortic stenosis (AS) was diagnosed by a previous physician and was followed up regularly.

Blood tests (X-130 days):

Cr 1.07md/dL,

AST 17IU/L,

ALT 9IU/L

Routine examination on X-32 revealed tachycardic atrial fibrillation with a decreased left ventricular ejection fraction (LVEF) of 45%.

Subsequently, the patient developed dyspnea and leg edema, and on X-3, was urgently admitted to his previous physician with a diagnosis of congestive heart failure and pneumonia.

Blood tests (X-3):

Cr 1.44md/dL,

AST 43IU/L,

ALT 38IU/L

Progressive liver and renal dysfunction was observed after admission, and the patient was transferred to our hospital on X day with a diagnosis of shock and multiple organ failure due to severe AS.

Blood tests (on X day):

Cr 1.73md/dL,

AST 547IU/L,

ALT 406IU/L

Current condition

158cm, 67kg

Consciousness JCS I-3,

Blood pressure 112/73mmHg,

Heart rate 147/min (irregular),

Respiratory rate 30 breaths/min,

Body temperature 37.4°C,

SpO₂ 100% (under noninvasive positive pressure ventilation [NPPV]),

Eyelid conjunctiva without anemia,

No jaundice in the ocular conjunctiva,

Jugular venous engorgement, with rales, present,

Systolic murmur at right border of 2nd intercostal sternum,

Flat and soft abdomen,

No tenderness,

Edema of lower legs,

Peripheral coldness and dampness

Chest X-ray Marked pulmonary congestion was observed. 12-lead ECG HR 145/min, atria...

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