Mr. Hung experienced intermittent left chest pain and shortness of breath for three months, seeking emergency care at Tam Anh General Hospital, Ho Chi Minh City, only when his condition worsened. Professor Vo Thanh Nhan, Director of the Interventional Cardiology Center, diagnosed him with acute heart failure superimposed on stage three chronic heart failure. An echocardiogram revealed severe aortic stenosis. This condition occurs when the aortic valve narrows, preventing it from opening fully, which reduces or blocks blood flow from the heart into the body's main artery (the aorta) and subsequently to the rest of the body.

According to Professor Nhan, the three most common symptoms of severe aortic stenosis are shortness of breath (due to severe heart failure), angina (insufficient blood supply to the heart muscle), and fainting (reduced blood flow to the brain). Mr. Hung exhibited all three signs, indicating his disease had progressed to its final stage, posing a risk of death without valve replacement.

Given Mr. Hung's advanced age, chronic obstructive pulmonary disease (COPD), and stage 4 kidney failure, he could not tolerate a prolonged surgical procedure. General anesthesia during surgery would also increase his risk of complications from intubation, most notably respiratory failure and acute heart failure.

Doctors check Mr. Hung's health on the second day after the intervention. *Photo: Trung Vu*

Professor Nhan stated that transcatheter aortic valve implantation (TAVI) was the most suitable method for the patient's condition. This minimally invasive technique involves only local anesthesia, eliminating the need for general anesthesia or sternotomy. TAVI is particularly appropriate for elderly patients with multiple underlying conditions.

Mr. Hung received medical treatment, including beta-blockers, diuretics, cardiac support medication, and vasodilators. After two weeks, his shortness of breath improved, his acute heart failure episode resolved, and he was scheduled for valve replacement.

The medical team identified the patient's severely calcified aorta as the primary challenge, making access more difficult compared to younger patients with softer, non-calcified aortas. Doctors performed balloon angioplasty to widen the vessel lumen before inserting the device. Mr. Hung's glomerular filtration rate was only 25 mL/min, meaning the amount of contrast dye used could not exceed 100 mL to prevent further kidney function decline post-intervention. The team carefully timed the contrast dye administration to minimize the quantity used and protect kidney function.

The patient's aortic arch was also horizontal and tortuous. Doctors selected a Sapien valve, a balloon-expandable type with a flexible catheter that could easily navigate the aortic pathway. The valve implantation procedure was straightforward and quick, minimizing the risk of acute heart failure. Within two hours, the new valve immediately began effectively pumping blood throughout the body. Mr. Hung's shortness of breath, fatigue, and chest pain resolved, and he was discharged after 5 days.

Professor Nhan (far left) and the team implant an aortic valve via catheter for the patient. *Photo: Trung Vu*

Aortic stenosis often presents with few symptoms in its early stages. Patients should be aware of suspicious signs such as chest pain, shortness of breath, fatigue, dizziness or fainting, and palpitations due to arrhythmias, and seek early medical attention.

Thu Ha