Aortic stenosis

Abstract

A 77-year-old female scheduled to have a right ankle fusion presented to the anesthesia preadmission clinic 2 weeks prior to surgery. She had previously been diagnosed with aortic stenosis. The most recent echocardiogram had been done 4 years preceding this visit and showed a valve area of 0.9 cm2, peak gradient across the aortic valve of 45 mm Hg, and a mean gradient of 23 mm Hg. Ejection fraction (EF) was 60%, and left ventricular hypertrophy was identified. Thereafter she had been lost to follow up as she had left the country for an extended period. She was obese with a body weight of 109 kg and BMI 45, hypertensive, and prediabetic. She was noted to have a history of chronic renal insufficiency. She denied any history of presyncope, syncope, or chest pain. She did complain of shortness of breath on exertion and had previously been designated New York Heart Association (NYHA) II.