{
  "abstract": "Background: Relieving the fixed afterload of severe aortic stenosis can unmask a previously concealed dynamic outflow-tract obstruction.\n\nCase summary: A 69-year-old man with severe aortic stenosis (valve area 0.65 cm2; 109/64 mmHg), mild concentric hypertrophy (septum 15 mm), and no baseline systolic anterior motion (SAM) underwent transcatheter aortic valve implantation (TAVI). The invasive peak-to-peak gradient fell from 64 to 7 mmHg, but echocardiography immediately afterwards showed new SAM and severe dynamic left-ventricular-outflow-tract (LVOT) obstruction (170/67 mmHg) with hypotension. Treatment was load-directed (volume expansion, avoidance of vasodilators and inotropes, beta-blockade), with a cardiac myosin inhibitor as an adjunct. Over 4 months the resting LVOT gradient fell to 22/13 mmHg and the provoked peak to 29 mmHg, with SAM no longer seen and preserved ejection fraction.\n\nDiscussion: Recognizing this load-dependent obstruction during the procedure and restoring loading, rather than escalating inotropes, is the key lesson.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "name": "Zongmei Gao"
    },
    {
      "name": "Minghui Yuan",
      "orcid": "0009-0006-1522-6434"
    },
    {
      "name": "Yi Li",
      "orcid": "0009-0002-7085-3116"
    },
    {
      "name": "Jingli Lu",
      "orcid": "0009-0009-1448-5970"
    },
    {
      "name": "Ruijian Li",
      "orcid": "0000-0001-9065-8575"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2fcecbnet8bq2.bib",
  "cited_by": 0,
  "doi": "10.1093/ehjcr/ytag755",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13696958/",
  "id": "2fcecbnet8bq2",
  "issns": [
    "2514-2119"
  ],
  "landing_url": "https://doi.org/10.1093/ehjcr/ytag755",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00200"
    ],
    [
      "heading",
      "Case Report"
    ],
    [
      "heading",
      "Eurheartj/30"
    ],
    [
      "heading",
      "Eurheartj/39"
    ],
    [
      "heading",
      "Eurheartj/41"
    ],
    [
      "heading",
      "Valvular Heart Disease"
    ],
    [
      "openalex",
      "2705|Cardiac Valve Diseases and Treatments"
    ]
  ],
  "openalex": "W7221826189",
  "pdf_url": "https://europepmc.org/articles/PMC13696958?pdf=render",
  "pmcid": "PMC13696958",
  "pmid": "42935739",
  "published": "2026-10-14",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/2fcecbnet8bq2.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:13Z",
      "native_id": "PMC13696958",
      "source": "pmc",
      "url": "https://doi.org/10.1093/ehjcr/ytag755"
    },
    {
      "first_seen": "2026-10-30T12:22:12Z",
      "native_id": "MED:42935739",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42935739"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac Valve Diseases and Treatments",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case report",
  "title_text": "Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case report",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:34:12Z",
  "url": "https://research.draconitic.com/paper/2fcecbnet8bq2",
  "venue": "European Heart Journal. Case Reports",
  "versions": []
}