[Aortic stenosis with low transvalvular pressure gradients and impaired left ventricular function. Dobutamine stress echocardiography helps in therapy planning].
BACKGROUND
Aortic valve replacement is recommended in case of symptomatic severe aortic stenosis. This decision is difficult for patients with low-gradient aortic stenosis and severely impaired left ventricular function because of high perioperative mortality in this group. Although aortic valve replacement is usually justified if severe aortic stenosis is proved, patients with primary myocardial dysfunction and subsequent reduced aortic valve opening do not benefit from aortic valve replacement. Distinguishing these two groups of patients is necessary but not possible with echocardiography at rest. Positive inotropic stimulation with dobutamine stress echocardiography enables a more reliable graduation of aortic stenosis under these circumstances.


METHODS
We report on a symptomatic 58-year-old man with aortic stenosis and severely impaired left ventricular function. Using echocardiography at rest, there was a severely reduced aortic valve area of 0.6 cm2 and a mean pressure gradient of 24 mm Hg. Determined by cardiac catheterization, the peak-to-peak gradient was 20 mm Hg and the aortic valve area calculated by the Gorlin formula was 0.6 cm2. After positive inotropic stimulation using dobutamine stress echocardiography, the aortic valve area increased to 1.5 cm2 indicating an only moderate aortic stenosis. Thus aortic valve replacement was not performed and myocardial failure was medically treated. After 1.5 years of follow-up, the patient is in good condition and without complaints.
Lichte
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S
Abteilung für Kardiologie und Pulmologie, Zentrum für Innere Medizin, Robert-Bosch-Krankenhaus Stuttgart.
Meinhardt
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G
Sechtem
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U
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001021:Aortic Valve / Q000187:drug effects / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002301:Cardiac Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004280:Dobutamine; D004359:Drug Therapy, Combination; D004452:Echocardiography; D005080:Exercise Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
D000806:Angiotensin-Converting Enzyme Inhibitors; D002301:Cardiac Glycosides; D004232:Diuretics; D004280:Dobutamine
Aortenstenose mit niedrigem transvalvulären Druckgradienten und eingeschränkter linksventrikulärer Funktion. Dobutamin-Stressechokardiographie hilft bei der Therapieplanung.