Transcatheter Aortic Valve Implantation from the Physician-as-Family Perspective

In the article, "TAVR: A Personal Experience," Dr. Kern describes a successful transcatheter aortic valve replacement (TAVR) procedure and gives his perspective from a new position - that of a family member accompanying the patient. The patient had little calcification of any of her major arteries, including the iliac arteries and aortic arch and ascending aorta. Further analysis of the CT scan also showed she had an aortic root suitable of accepting a large Sapien Edwards 26mm valve. Echocardiography confirmed previous findings of pulmonary hypertension, very large left atrium, mild mitral regurgitation and normal left ventricular function. Before TAVR, the left ventricular-ascending aortic (LV-Ao) gradient was nearly 80mmHg, and after TAVR, the gradient is not only abolished, but there is restoration of a completely normal aortic pressure contour and matching LV tracing, including the anachrotic shoulder as well as a distinct dichrotic notch, neither feature present before implanting the valve.