Hemodynamic Evaluation of Concomitant Aortic Stenosis and Hypertrophic Obstructive Cardiomyopathy With Pressure Wire

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Imaging

Background:

• Concomitant severe aortic stenosis (AS) and hypertrophic obstructive cardiomyopathy (HOCM) present complex diagnostic and therapeutic challenges.
• Overlapping hemodynamic profiles of AS and left ventricular outflow tract (LVOT) obstruction can render imaging modalities inconclusive.
• Accurate differentiation is crucial for appropriate management and improved patient outcomes.

Purpose of the Study:

• To illustrate the utility of invasive hemodynamic assessment using pressure wire technology.
• To demonstrate the successful management of a patient with combined severe AS and HOCM.
• To highlight the role of pressure wire assessment in guiding procedural planning for complex cardiac conditions.

Main Methods:

• Case presentation of an 89-year-old female with severe AS and suspected LVOT obstruction.
• Utilized invasive hemodynamic assessment with a pressure wire to differentiate and quantify AS and LVOT gradients.
• Assessed hemodynamic response to premature ventricular contractions (PVCs) to further characterize LVOT obstruction.
• Performed alcohol septal ablation followed by transcatheter aortic valve replacement (TAVR).

Main Results:

• Imaging modalities were inconclusive in differentiating severe AS from LVOT obstruction.
• Pressure wire assessment precisely quantified both AS and LVOT gradients, including dynamic changes with PVCs.
• Alcohol septal ablation effectively reduced the LVOT gradient.
• Subsequent TAVR was performed safely with improved hemodynamic parameters.

Conclusions:

• Pressure wire techniques are invaluable for precise hemodynamic assessment in patients with dual pathology (AS and HOCM).
• Invasive assessment guides effective therapeutic strategies, such as alcohol septal ablation prior to TAVR.
• This approach enables safe and successful management of complex cardiovascular conditions, improving patient outcomes.