Implications of normal left ventricular wall thickness in critical aortic stenosis

It is standard practice for clinicians to consider echocardiographically-measured left ventricular wall thickness when estimating the severity of aortic stenosis. Most consider the degree of wall thickness above normal limits is in proportion to ventricular hypertrophy. Employment of wall thickness information to assess aortic stenosis severity, while generally reliable, can occasionally be misleading. Two cases are presented with findings of severe, critical aortic stenosis and normal wall thickness. In each case, left ventricular contractile function was markedly impaired and the patient markedly symptomatic.