Beyond Severe AS: Exploring TAVR in Moderate Aortic Stenosis and Subvalvular HOCM-Related Obstruction
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
Journal of the American College of Cardiology
Abstract
Background: A 69-year-old female with hypertrophic obstructive cardiomyopathy (HOCM) presented with acute heart failure and worsening hemodynamics. Despite moderate aortic stenosis (AS) and a negative ischemic workup, her combination of HOCM, AS, and heart failure led to cardiogenic shock. Urgent extracorporeal membrane oxygenation (ECMO) and transcatheter aortic valve replacement (TAVR) significantly improved her condition. This case highlights the complexity of managing concurrent obstructive lesions and supports early TAVR intervention in moderate AS complicated by HOCM-related LVOT obstruction. Case: A 69-year-old female with HOCM presented with acute heart failure. Transthoracic echocardiogram (TTE) showed a drop in left ventricular ejection fraction from 55% to 40%. Ischemic workup was negative, and TEE revealed moderate AS with an aortic valve area of 1.05 cm², peak gradient of 62 mmHg, and mean gradient of 32 mmHg. The patientʼs condition worsened, leading to cardiogenic shock. Given her rapid decline, TAVR was performed despite not meeting standard criteria, and ECMO was initiated. Post-TAVR, her LVEF improved significantly. Decision-making: Managing coexisting HOCM and AS in cardiogenic shock is challenging. Standard AS assessments—peak velocities, pressure gradients, and aortic valve area (AVA)—are complicated by subvalvular obstruction, reducing stroke volume and potentially underestimating AS severity. Invasive evaluation clarifies HOCM and AS contributions to obstruction. In this case, ECMO-supported TAVR aimed to relieve AS-related obstruction and reduce afterload mismatch, contributing to cardiogenic shock. Conclusion: This case highlights the need for careful planning and hemodynamic assessment when managing HOCM and AS. Early TAVR for moderate AS can stabilize patients, even without traditional severe AS criteria, when cardiogenic shock is present.
Volume
85
Issue
12 Suppl
First Page
3087
Last Page
3087
Recommended Citation
Jamil M, Egbe Bessong Tabor A, El-Gammal A, Gunaseelan L. Beyond severe AS: exploring TAVR in moderate aortic stenosis and subvalvular HOCM-related obstruction. J Am Coll Cardiol. 2025 Apr 1;85(12 Suppl):3087. doi:10.1016/S0735-1097(25)03571-5
DOI
10.1016/S0735-1097(25)03571-5
Comments
American College of Cardiology (ACC) Meeting, March 29-31, 2025, Chicago, IL