Transcript

 - We have a 72 year old Caucasian female who presented to the emergency room at Clements University Hospital, here at UT Southwestern, who presented with symptoms of heart failure and chest tightness that had been going on for several weeks. We felt that the patient had signs and symptoms that where consistent with severe aortic stenosis, in addition to heart failure. She had a history of a transcatheter aortic valve replacement that had been preformed at another institution about three years ago. And so for her to have had this dramatic progression of symptoms, and again have these finding consistent with severe aortic stenosis was a little unusual. So we where asked to see her as part of the structural heart team, given her history of transcatheter aortic valve replacement and this new diagnosis of aortic stenosis. So the first step we decided we should get an echocardiogram on her. This was the echo image and this was a little interesting in that this is the parasternal long axis on the echo, and you can see here is the aortic valve, and it appears to be a lot of calcium, at least a lot of echogenicity around the aortic valve. So based on the echo findings, we decided to investigate this further with a CT scan. And once we got the CT scan we actually found something that we weren't looking for and were really surprised, and at first didn't actually believe. Now that you've seen the scan, its up for you to try to figure out what's wrong with this lady and how to manage that?