PMC8488101_01
Changes of peak jet velocity and pressure gradient of aortic valve and left ventricular outflow track.
fcvm-08-735219-g0001.jpg
PMC8488101_01_fcvm-08-735219-g0001.jpg
F1
TTE suggested severe aortic stenosis (AS) (peak jet velocity 4.6 m/s, mean pressure gradient 49 mmHg) combined with LVOTO (peak jet velocity 4.8 m/s, maximum pressure gradient 93 mmHg) (Figure 1). AVL, and V5), and depressed ST segment at leads I and AVL (Figure 4A). After a 26-mm self-expandable Venus A-valve was successfully deployed, the post-TAVR mean pressure gradient decreased to 17 mmHg and peak jet velocity to 2.8 m/s, but LVOTO remained unchanged (Figure 1, Supplementary Videos 5, 6). LVOTO (peak jet velocity 4.4 m/s and maximum pressure gradient 77 mmHg) (Figure 1) and septal thickening were still shown by TTE and CT; delayed enhancement of myocardium was confirmed by cardiac magnetic resonance imaging (CMR) (Figures 2C-E). The mean pressure of the aortic valve reached 7 mmHg (Figure 1). After follow-up at 2 years after TAVR, 1.5 years after PIMSRA, the patient's symptoms remained stable, and echocardiography showed peak jet velocity of aortic valve, peak jet velocity of LVOT, and thickness of septa of 2.5 m/s, 2.1 m/s, and 13 mm, respectively (Figure 1; Supplementary Video 9).
Imaging characteristics of interventricular septa. (A) Thickened interventricular septa was confirmed by TTE of 17.0 mm. (B) Thickened interventricular septa was confirmed by CT of 16.09 mm. (C) Left ventricular contrast echocardiography shows thickened interventricular septa of 16.7 mm at 6-month follow-up after TAVR. (D) Thickened interventricular septa was confirmed by CT of 17.7 mm at 6-month follow-up after TAVR. (E) Myocardial fibrosis and delayed enhancement was confirmed by cardiac magnetic resonance. (F) Interventricular septal thickness decreased to 13.0 mm after PIMSRA 5 days later. Red arrows: delayed enhancement.
fcvm-08-735219-g0002.jpg
PMC8488101_01_fcvm-08-735219-g0002.jpg
F2
Interventricular septal thickening (16-17 mm) was confirmed by TTE and CT (Figures 2A,B; Supplementary Videos 1, 2). LVOTO (peak jet velocity 4.4 m/s and maximum pressure gradient 77 mmHg) (Figure 1) and septal thickening were still shown by TTE and CT; delayed enhancement of myocardium was confirmed by cardiac magnetic resonance imaging (CMR) (Figures 2C-E). The maximum pressure gradient of LVOT decreased to 12 mmHg after PIMSRA immediately (Figure 2F; Supplementary Videos 7, 8), and the thickness of the septa decreased to 13 mm 5 days later.
Type-0 bicuspid aortic valve orifice area measured by echocardiography and CT. (A) Aortic valve orifice area was 0.94 cm2 measured by TTE. (B) Aortic valve orifice area was 0.96 cm2 measured by CT of systolic phase.
fcvm-08-735219-g0003.jpg
PMC8488101_01_fcvm-08-735219-g0003.jpg
F3
Aortic valve area was 0.94 cm2 measured by echocardiography and was 0.96 cm2 measured by CT of systolic phase (Figures 3A,B; Supplementary Videos 3, 4).
ECGs at different times. (A) Pre-TAVR ECG. (B) Post-TAVR ECG. (C) ECG at 6-month follow-up after TAVR.
fcvm-08-735219-g0004.jpg
PMC8488101_01_fcvm-08-735219-g0004.jpg
F4
AVL, and V5), and depressed ST segment at leads I and AVL (Figure 4A). After a 26-mm self-expandable Venus A-valve was successfully deployed, the post-TAVR mean pressure gradient decreased to 17 mmHg and peak jet velocity to 2.8 m/s, but LVOTO remained unchanged (Figure 1, Supplementary Videos 5, 6). There was no significant change observed by post-TAVR six-lead ECG without any complications of conduction block (Figure 4B). TAVR, he complained of dyspnea again with NYHA functional class III. There were no significant changes in the follow-up 12-lead ECG (Figure 4C).
Difference of ventricular septal thickness between valvular aortic stenosis and hypertrophic cardiomyopathy. Comparison of ventricular septal thickness in 85 patients with valvular aortic stenosis (AS) and 151 patients with hypertrophic cardiomyopathy (HCM), studied with echocardiography and at necropsy.
fcvm-08-735219-g0005.jpg
PMC8488101_01_fcvm-08-735219-g0005.jpg
F5
AVL, and V5), and depressed ST segment at leads I and AVL (Figure 4A). After a 26-mm self-expandable Venus A-valve was successfully deployed, the post-TAVR mean pressure gradient decreased to 17 mmHg and peak jet velocity to 2.8 m/s, but LVOTO remained unchanged (Figure 1, Supplementary Videos 5, 6).