Isolated aortic stenosis with severe pulmonary hypertension

Area of Science:

• Cardiology
• Pulmonary Hypertension
• Valvular Heart Disease

Background:

• Severe pulmonary hypertension (PH) is uncommon in aortic stenosis (AS).
• PH in AS typically suggests coexisting mitral valve disease, impaired left ventricular (LV) function, or pulmonary pathology.
• This case explores PH in isolated AS with preserved LV systolic function.

Observation:

• A patient presented with severe PH and isolated severe AS.
• The patient exhibited normal left ventricular systolic function.
• Left ventricular diastolic dysfunction was suspected as the cause of PH.

Findings:

• Successful aortic valve replacement (AVR) led to a reduction in pulmonary pressures.
• Despite AVR, persistent shortness of breath was noted post-operatively.
• The patient continued to require daily diuretic therapy for symptom management.

Implications:

• Left ventricular diastolic dysfunction can be a significant, albeit rare, cause of severe PH in isolated AS.
• Aortic valve replacement may not fully resolve all symptoms in such complex cases.
• Ongoing management for residual symptoms, like shortness of breath, is crucial post-surgery.