Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case report
Abstract
Background: Relieving the fixed afterload of severe aortic stenosis can unmask a previously concealed dynamic outflow-tract obstruction.
Case 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.
Discussion: Recognizing this load-dependent obstruction during the procedure and restoring loading, rather than escalating inotropes, is the key lesson.
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BibTeX
@article{gao2026severe,
title = {{Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case report}},
author = {Zongmei Gao and Minghui Yuan and Yi Li and Jingli Lu and Ruijian Li},
journal = {European Heart Journal. Case Reports},
year = {2026},
month = oct,
doi = {10.1093/ehjcr/ytag755},
url = {https://doi.org/10.1093/ehjcr/ytag755},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case report
AU - Zongmei Gao
AU - Minghui Yuan
AU - Yi Li
AU - Jingli Lu
AU - Ruijian Li
PY - 2026
DA - 2026/10/14
JO - European Heart Journal. Case Reports
DO - 10.1093/ehjcr/ytag755
UR - https://doi.org/10.1093/ehjcr/ytag755
AB - Background: Relieving the fixed afterload of severe aortic stenosis can unmask a previously concealed dynamic outflow-tract obstruction. Case 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. Discussion: Recognizing this load-dependent obstruction during the procedure and restoring loading, rather than escalating inotropes, is the key lesson.
SN - 2514-2119
ER -