2021-10-07 06:32:09
The initial part of the recording shows a gradient between LV and systemic arterial pressure, suggesting AS or subaortic stenosis (peak-topeak gradient 80 mmHg). The pullback across the LVOT shows that
there is no gradient between LVOT and the femoral artery, establishing
the diagnosis of subaortic stenosis, likely HOCM. Note that the arterial
pressure is bifid, which also favors HOCM over AS or fixed (membranous) subaortic stenosis.
After pulling back the LV catheter into the aorta, verify that the
aortic pressure superimposes on the femoral pressure, that is, verify
the lack of discrepancy between the aortic and femoral pressures. A
discrepancy may result from peripheral systolic amplification of the
femoral arterial pressure or from reduction of the femoral arterial pressure in aortoiliac disease.
Note that a similar tracing may be obtained by simultaneously
recording the ascending aortic pressure using a JR4 catheter and the LV
pressure using a pressure wire advanced through the JR4 catheter and
pulled back across the LV.
As a general rule, the peripheral arterial waveform is more spread
out (widened) than the aortic waveform. This explains the widening of
the femoral arterial tracing in this case
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