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Updated: Oct 28, 2026

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
Published on: January 20, 2022
Severe dynamic left-ventricular outflow-tract obstruction unmasked by transcatheter aortic valve implantation: a case
Zongmei Gao1, Minghui Yuan1, Yi Li1
1Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 42 Wenhua West Road Jinan, 250011 Shandong, People's Republic of China.
Background:
Relieving the fixed afterload of severe aortic stenosis can unmask a previously concealed dynamic outflow-tract obstruction.
Case Summary:
A 69-year-old man with severe aortic stenosis (valve area 0.65 cm2; 109/64 mmHg), mild concentric hypertrophy (septum 15 mm), and no baseline systolic anterior motion (SAM) underwent transcatheter aortic valve implantation (TAVI). The invasive peak-to-peak gradient fell from 64 to 7 mmHg, but echocardiography immediately afterwards showed new SAM and severe dynamic left-ventricular-outflow-tract (LVOT) obstruction (170/67 mmHg) with hypotension. Treatment was load-directed (volume expansion, avoidance of vasodilators and inotropes, beta-blockade), with a cardiac myosin inhibitor as an adjunct. Over 4 months the resting LVOT gradient fell to 22/13 mmHg and the provoked peak to 29 mmHg, with SAM no longer seen and preserved ejection fraction.
Discussion:
Recognizing this load-dependent obstruction during the procedure and restoring loading, rather than escalating inotropes, is the key lesson.
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