Case history / examination:
An 85-year-old woman was referred to us with refractory heart failure after surgical AVR with a 21-mm CROWN PRT (Sorin Group USA Inc., Arvada, CO, USA) and partial septal myomectomy for severe aortic stenosis. Transthoracic echocardiography revealed exacerbated obstruction of the left ventricular outflow tract (LVOT) with a gradient of 200 mmHg and severe mitral regurgitation (MR) with systolic anterior motion (SAM) after surgical AVR (Figure 1a and b). Invasive studies using a PressureWireâ„¢ X Guidewire (Abbott Vascular, Abbott Park, IL, USA) revealed real-time pressure gradients between left ventricular pressure and aortic pressure (Figure 1c). The LVOT pressure gradient was 100 mmHg. No differences were observed between these two values while retracting the pressure wire (Figure 1d and e).