Case Studies in physiology: Cheyne-Stokes respiration and cardiovascular oscillations ending abruptly when deploying transfemoral aortic valve release_6r7tjzwd6jf3zjvahiovhetjue

by David Kahn, Philippe Baele, Agnes Pasquet, Giuseppe Liistro

Published in Journal of applied physiology by American Physiological Society.

2019  

Abstract

A 86 year-old gentleman was referred for trans-femoral aortic valve implantation. Transthoracic echocardiography revealed a severe stenosis (mean gradient 58 mmHg, aortic valve area: 0.4 cm2) and after multidisciplinary discussion, the risk of surgery was judged too high (logistic Euroscore: 51%) and the patient was proposed for a trans-femoral aortic valve implantation (TAVI). On arrival in the operating room the patient, fully conscious, was noted to have Cheyne-Stokes breathing (CSB), persisting after 40 % oxygen administration. TAVI procedure was successful and CSB pattern was interrupted within 8 seconds. To the best of our knowledge, this report is the first to show an acute disappearance of CSB, occurring only seconds after TAVI and restoration of a normal hemodynamic situation. To explain such rapid changes in breathing pattern we hypothesize a role played by the acute release of pulmonary hypertension and pulmonary volume overload.
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