title: Complete interventional heart repair of multiple concomitant cardiac pathologies in a staged approach.
abstract: OBJECTIVE
  The evidence of multiple percutaneous cardiac procedures in patients with numerous concomitant cardiac pathologies is limited.
  
  
  RESULTS
  We report on the case of a 90-year-old male patient presenting with advanced heart failure because of degenerative aortic valve stenosis and degenerative mitral valve regurgitation. Moreover, significant coronary artery disease and intolerance of anticoagulation in atrial fibrillation were present. The patient was rejected from surgery because of age and frailty and underwent a staged interventional procedure with percutaneous coronary intervention, followed by transfemoral aortic valve implantation with Edwards Sapien XT, percutaneous mitral valve repair with MitraClip, and left atrial appendage closure with Amplatzer Cardiac Plug. The last procedure was complicated by pericardial tamponade necessitating pericardial drainage. Eight weeks later, the patient reported on the absence of dyspnea in activities of daily living and a significant gain in quality of live.
  
  
  CONCLUSIONS
  The case demonstrates feasibility of a staged interventional approach in a select high-risk patient.
authors.affiliation: Universitätsmedizin Göttingen, Department of Cardiology, Georg August University of Göttingen, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Puls
authors.forename: Ralf
authors.initials: R
authors.lastname: Seipelt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
mesh_terms: D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D011474:Prosthesis Design; D055989:Septal Occluder Device; D015607:Stents; D016896:Treatment Outcome