Clinical introduction
A man in his 60s was admitted to our hospital for surgical aortic valve replacement for severe aortic stenosis due to a bicuspid aortic valve. Although left ventricular (LV) hypertrophy was noted in his childhood, the details were not clarified. The 12-lead ECG showed normal sinus rhythm with a heart rate of 100 beats per minute and complete left bundle branch block. Transthoracic echocardiography revealed LV outflow tract obstruction due to systolic anterior motion of the mitral valve in addition to marked LV hypertrophy (figure 1A,B). The peak pressure gradient across the LV outflow tract was calculated to be 164 mm Hg using the modified Bernoulli equation (figure 1C). An apical sparing pattern of LV longitudinal strain was observed using two-dimensional speckle tracking (figure 1D). Surgical aortic valve replacement and LV outflow tract release were performed. However, he developed malignant…
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