Severe Aortic Stenosis and ATTRwt Amyloidosis – Beware in the Aging: A Case Report and Review of the Literature

Severe Aortic Stenosis and ATTRwt Amyloidosis – Beware in the Aging: A Case Report and Review of the Literature

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Robert Adam,1,2 Alice Munteanu,3 Raluca Mititelu,4 Sebastian Onciul,2,5 Dan Deleanu,1 Vlad Anton Iliescu,2,6 Bogdan A Popescu,1,2 Ruxandra Jurcut1,2 1Department of Cardiology, “Prof.Dr.C.

C.Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania; 2“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 3Department of Cardiology, Emergency University Central Military Hospital, Bucharest, Romania; 4Department of Nuclear Medicine, Emergency University Central Military Hospital, Bucharest, Romania; 5Department of Cardiology, Clinical Emergency Hospital, Bucharest, Romania; 6Department of Cardiovascular Surgery, “Prof.Dr.

C.C.Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, RomaniaCorrespondence: Ruxandra Jurcut Email rjurcut@gmail.

comAbstract: Degenerative aortic valve (AV) disease is the most frequent valvular heart Walkers + Wagons disease slowly progressing to severe aortic stenosis (AS) which usually requires aortic valve replacement.Another frequent condition, especially among elderly people, is cardiac amyloidosis (CA), particularly the wild-type transthyretin cardiac amyloidosis (ATTRwt).Since both of these diseases are considered a marker of ageing, there is a significant proportion of elderly patients who associate both severe AS and CA.

Recent studies reported a high prevalence of both severe AS and CA (AS-CA) in elderly patients referred for TAVR of 13– 16%, carrying a worse prognosis.The present case illustrates the diagnostic algorithm and the management of ATTRwt CA in an elderly patient with severe paradoxical low-flow low-gradient AS, accompanied by a review of the current literature about the red flags which help identifying CA in patients with severe AS, as well as the prognosis and management of these disease association.Keywords: aortic stenosis, cardiac amyloidosis, wild-type ATTR, transcatheter Barber Brush aortic valve replacement, conduction disorders.