{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:56:43Z","timestamp":1787237803585,"version":"build-2736575974"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We report the case of a 77-year-old woman presenting with a hypertrophic cardiomyopathy phenotype characterized by hemodynamically significant dynamic left ventricular outflow tract obstruction (LVOTO) due to mitral systolic anterior motion (SAM), in association with aortic stenosis (AS). The clinical presentation included an episode of syncope, followed by progressive exertional dyspnea. Initial transthoracic echocardiography revealed marked septal hypertrophy, a calcified aortic valve with elevated transvalvular gradients, and SAM-induced dynamic LVOTO. Sarcomeric hypertrophic cardiomyopathy (HCM) and its phenocopies were subsequently excluded from the study. Transesophageal echocardiography confirmed the coexistence of severe AS and SAM. Given the complexity of the patient\u2019s cardiac condition and the presence of a \u201cporcelain aorta,\u201d both surgical and transcatheter aortic valve replacement were deemed high risk. We discuss the diagnostic and therapeutic challenges of this \u201cdouble-threat\u201d scenario \u2013 severe aortic stenosis combined with dynamic LVOTO \u2013 and review the relevant literature regarding its hemodynamic implications, imaging strategies, and management approaches, including the concept of the \u201csuicide left ventricle\u201d.<\/jats:p>","DOI":"10.4103\/jcecho.jcecho_95_25","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:04:24Z","timestamp":1778144664000},"page":"190-198","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Concomitant Dynamic Left Ventricular Outflow Tract Obstruction and Severe Aortic Stenosis a Case Report and a Literature Review"],"prefix":"10.4103","volume":"36","author":[{"given":"Tommaso","family":"Crovetto","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Sciences, Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Vagnarelli","sequence":"additional","affiliation":[{"name":"Cardiology Division, Lancisi Cardiovascular Center, Marche University Hospital, Ancona, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito Maurizio","family":"Parato","sequence":"additional","affiliation":[{"name":"Cardiology and Cardiac Rehabilitation Unit, Madonna del Soccorso Hospital \u2013 AST\/AP, San Benedetto del Tronto, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Barbarossa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Sciences, Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Marche, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"R1-20260527","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1161\/CIR.0000000000001123","article-title":"Heart disease and stroke statistics-2023 update:A report from the American Heart Association","volume":"147","author":"Tsao","year":"2023","journal-title":"Circulation"},{"key":"R2-20260527","doi-asserted-by":"crossref","first-page":"5555","DOI":"10.3390\/jcm13185555","article-title":"Silent threats of the heart:A case series and narrative review on suicide left ventricle post-aortic valve replacement in patients with dynamic LVOT obstruction and aortic stenosis","volume":"13","author":"Romano","year":"2024","journal-title":"J Clin Med"},{"key":"R3-20260527","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.case.2024.10.002","article-title":"Aortic stenosis with dynamic left ventricular outflow obstruction:Diagnostic and management challenges-A case series","volume":"9","author":"Qian","year":"2024","journal-title":"CASE (Phila)"},{"key":"R4-20260527","doi-asserted-by":"crossref","first-page":"e11","DOI":"10.15420\/icr.2020.36","article-title":"Haemodynamic Interplay between concomitant left ventricular outflow tract obstruction and aortic stenosis","volume":"16","author":"Bansal","year":"2021","journal-title":"Interv Cardiol"},{"key":"R5-20260527","first-page":"129","article-title":"A case of hypertrophic obstructive cardiomyopathy with aortic stenosis","volume":"9","author":"Ishimura","year":"2014","journal-title":"J Cardiol Cases"},{"key":"R6-20260527","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1111\/echo.12935","article-title":"Dynamic LVOT Obstruction and Aortic Stenosis in the Same Patient:A Case of Challenging Doppler Hemodynamics","volume":"32","author":"Parker","year":"2015","journal-title":"Echocardiography"},{"key":"R7-20260527","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1093\/ehjci\/jew335","article-title":"Recommendations on the echocardiographic assessment of aortic valve stenosis:A focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography","volume":"18","author":"Baumgartner","year":"2017","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"R8-20260527","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.echo.2011.03.006","article-title":"American Society of Echocardiography;American Society of Nuclear Cardiology;Society for Cardiovascular Magnetic Resonance;Society of Cardiovascular Computed Tomography. 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