Prosthetic heart valve

A 55-year-old invasive/clinical car-diologist worked full time, exer-cised regularly, and was asymptomatic. Two weeks previously, he had new onset of angina on exertion. Echocar-diography/Doppler and cardiac cathe-terization confirmed the clinical as-sessment of severe aortic stenosis with a valve area of 0.5 cm2/m2. The aortic valve was tricuspid; left ventricular ejection fraction was 0.60. Coronary arteriography showed no obstructive coronary artery disease. His body-mass index was 23 kg/m2, body sur-face area 1.7 m2, blood pressure 110/ 70 mm Hg, low-density lipoprotein 70 mg/dL, creatinine clearance 120 mL