Simultaneous Intracardiac Pressure Measurement to Detect the Origin of Pressure Gradient in a Patient with Coexisting Aortic Stenosis and Asymmetrical Interventricular Septal Hypertrophy

Patient: Female, 64 Final Diagnosis: Aortic stenosis Symptoms: Short of breath Medication: — Clinical Procedure: Aortic valve replacement Specialty: Cardiology OBJECTIVE: Challenging differential diagnosis BACKGROUND: Both aortic stenosis (AS) and left ventricular outflow tract (LVOT) obstruction can cause a pressure gradient along the LVOT. The interference caused by these 2 stenotic diseases are still not well understood, which might make echocardiographic evaluation difficult. CASE REPORT: A 60-year-old female was referred with occasional chest discomfort. Echocardiography revealed AS and asymmetrical hypertrophy of the basal interventricular septum (IVS). Continuous-wave Doppler recordings from the LV apex along a line oriented through the aortic valve showed a high velocity: peak velocity, 4.1 m/s; peak pressure gradient, 67.1 mmHg. Based on echocardiographic findings, the main cause of the pressure gradient was likely AS, but the coexistence of LVOT obstruction could not be ruled out. Therefore, simultaneous intracardiac pressure measurement was performed to detect the precise origin of the pressure gradient. This revealed that AS was the main cause of the pressure gradient. In addition to baseline measurement, measurement during continuous isoproterenol infusion was applied, which denied a latent LVOT obstruction. Elective aortic valve replacement improved the patient’s symptoms and decreased IVS thickness. CONCLUSIONS: Simultaneous intracardiac pressure measurement was effective to detect the origin of pressure gradient in a patient with severe AS accompanied by asymmetrical IVS hypertrophy. This experience provides insight into the clinical assessment of coexisting stenotic diseases and the association between AS and asymmetrical IVS hypertrophy.