High left ventricular outflow tract gradient: Aortic stenosis, obstructive hypertrophic cardiomyopathy or both?

The authors report the case of a patient diagnosed with both hypertrophic cardiomyopathy and aortic stenosis. Due to clinical deterioration, additional investigation was performed, and a high left ventricular outflow tract gradient was identified. Correct identification of the condition causing the...

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Bibliographic Details
Main Authors: Inês Almeida, Francisca Caetano, Joana Trigo, Paula Mota, António Leitão Marques
Format: Article
Language:English
Published: Elsevier 2015-05-01
Series:Revista Portuguesa de Cardiologia (English Edition)
Online Access:http://www.sciencedirect.com/science/article/pii/S2174204915000768
Description
Summary:The authors report the case of a patient diagnosed with both hypertrophic cardiomyopathy and aortic stenosis. Due to clinical deterioration, additional investigation was performed, and a high left ventricular outflow tract gradient was identified. Correct identification of the condition causing the symptoms was challenging, and involved several imaging techniques, the contribution of transesophageal echocardiography being crucial. The final diagnosis of severe aortic stenosis led to successful valve replacement surgery. The presence of these two conditions in the same patient has been documented, although it is uncommon. This association poses particular diagnostic and therapeutic challenges, which are discussed in this paper. Resumo: Os autores apresentam o caso de uma doente com os diagnósticos de miocardiopatia hipertrófica e estenose aórtica, na qual foi identificada a presença de um gradiente elevado ao nível do trato de saída do ventrículo esquerdo. O reconhecimento da patologia responsável pela sintomatologia foi desafiante, com envolvimento de várias técnicas de imagem, tendo sido fundamental a contribuição do ecocardiograma transesofágico. O diagnóstico final de estenose aórtica severa conduziu à referenciação para cirurgia de substituição valvular, com sucesso. A presença destas duas patologias em simultâneo num mesmo doente é conhecida, embora incomum. A sua combinação cria importantes desafios diagnósticos e terapêuticos, os quais serão objeto de discussão neste artigo. Keywords: Aortic valve stenosis, Hypertrophic cardiomyopathy, Left ventricular outflow tract obstruction, Echocardiography, Doppler echocardiography, Palavras-chave: Estenose aórtica, Cardiomiopatia hipertrófica, Obstrução do trato de saída do ventrículo esquerdo, Ecocardiografia, Ecocardiografia Doppler
ISSN:2174-2049