{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T20:42:24Z","timestamp":1778186544301,"version":"3.51.4"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T00:00:00Z","timestamp":1677715200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,6]]},"abstract":"Abstract<\/jats:title>Background<\/jats:title>Left ventricular outflow tract (LVOT) obstruction may occur with aortic stenosis (AS). However, the severity of AS is difficult to determine in this condition because the dynamic pressure gradient in LVOT obstruction influences the blood flow across the aortic valve.<\/jats:p><\/jats:sec>Case summary<\/jats:title>A 74-year-old woman was referred to our hospital having complaints of exertional dyspnoea and chest pain. Transthoracic echocardiography demonstrated LVOT obstruction with peak pressure gradient of 93\u2005mmHg and \u2018moderate\u2019 AS with 3.9\u2005m\/s peak velocity and mean pressure gradient of 26\u2005mmHg. Coronary angiography did not indicate any significant coronary artery disease. The pressure gradients at LVOT and aortic valve were measured as 34\u2005mmHg and 76\u2005mmHg via a pressure wire-pullback analysis, respectively. Intravenous 2 mg propranolol and 70 mg cibenzoline were administered to minimize the LVOT obstruction. Subsequently, these pressure gradients changed to 2\u2005mmHg and 96\u2005mmHg, respectively. The patient was finally diagnosed with \u2018severe\u2019 AS concomitant with LVOT obstruction. Therefore, surgical aortic valve replacement and myectomy were performed to remove the double obstruction.<\/jats:p><\/jats:sec>Discussion<\/jats:title>Herein, we present a case of \u2018double\u2019 LVOT obstruction due to dynamic myocardial component and fixed aortic component. Although the severity of AS is known to be influenced by LVOT obstruction, the present case is novel to demonstrate the phenomenon by using a pressure wire during pharmacological intervention. An accurate evaluation of the AS severity is important to provide adequate treatment. Therefore, the severity of AS should be evaluated while minimizing the LVOT obstruction.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad115","type":"journal-article","created":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T07:30:53Z","timestamp":1677828653000},"source":"Crossref","is-referenced-by-count":2,"title":["Unmasking the severity of aortic stenosis by pharmacological elimination of left ventricular outflow tract obstruction: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6724-3782","authenticated-orcid":false,"given":"Yoshihiro","family":"Harano","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Gifu Heart Center , 14-4 Yabutaminami, Gifu City, Gifu , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiaki","family":"Kawase","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Gifu Heart Center , 14-4 Yabutaminami, Gifu City, Gifu , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitoshi","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Gifu Heart Center , 14-4 Yabutaminami, Gifu City, Gifu , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"key":"2023031805260157300_","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1093\/eurheartj\/9.suppl_E.71","article-title":"Valvular aortic stenosis and asymmetric septal hypertrophy: diagnostic considerations and clinical and therapeutic implications","volume":"9","author":"Panza","year":"1988","journal-title":"Eur Heart J"},{"key":"2023031805260157300_","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0002-8703(51)90002-6","article-title":"Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. 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