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

Abstract

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.

Keywords: Aortic valve stenosis; Cardiomiopatia hipertrófica; Doppler echocardiography; Echocardiography; Ecocardiografia; Ecocardiografia Doppler; Estenose aórtica; Hypertrophic cardiomyopathy; Left ventricular outflow tract obstruction; Obstrução do trato de saída do ventrículo esquerdo.