The patient is 79-year-old women has severe aortic stenosis and 2-vessel coronary artery disease s/p coronary artery bypass graft who lives independently and is very active who presented to the emergency department for acute dyspnea.

Seven years earlier she was diagnosed with coronary artery disease. Cardiac catheterization at the time showed a left dominant system with moderate stenosis of the proximal LCx and severe stenosis of proximal PDA, and severe stenosis of the proximal LAD. She had a saphenous vein skip graft to the LCx and PDA, and a internal thoracic artery (LIMA) graft to the mid-LAD. She has declined surgery for her aortic stenosis and has a valve area of 1.1