How should I treat a patient with a symptomatic and severe low-flow low-gradient aortic stenosis and an incidental abdominal aortic aneurysm?

BACKGROUND: An 88-year-old male with a symptomatic severe low-flow low-gradient aortic stenosis was referred for catheter-based treatment (STS 7.7%). INVESTIGATION: Transthoracic echocardiography showed a severe low-flow low-gradient aortic stenosis (peak velocity of 2.9 m/s, AVA 0.6 cm2, LVEF 30%). CT during work-up revealed an unexpected finding of a large fusiform infrarenal AAA with a diameter of 59 mm, a mural thrombus and dissection. DIAGNOSIS: Severe low-flow low-gradient aortic stenosis and a large fusiform infrarenal AAA with mural thrombus and dissection. MANAGEMENT: The strategy was to treat both conditions in the same setting ("one-stop shop") using a complete percutaneous approach under local anaesthesia. Immediately after transfemoral implantation of an Edwards S3 29 mm, a Medtronic Endurant II endograft was implanted in the abdominal aorta.

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