A case of low-flow low-gradient aortic stenosis with repeated heart failure after arteriovenous fistula creation

Kodama Takuya, Yamano Yukiko, Okamoto Kota, Ishimoto Moriki, Naitou Tomomi, Hata Yuki, Omichi Tatsuya, Fujita Keiichi, Kita Ayako, Osawa Kosuke, Kita Hiromitsu, Iseki Keiko, Kunimoto Satoko, Tanaka Yusuke, Yano Takuro, Nakashima Yuri, Yamamoto Shuto, Ohya Masaki, Shigematsu Takashi, Araki Shin-ichi

doi:10.4009/jsdt.56.289

<p>The case involved a 75-year-old man on maintenance hemodialysis who frequently underwent repeated shunt stenosis. He was suspected of having low-flow low-gradient aortic stenosis based on echocardiography performed before surgery for an arteriovenous fistula newly replaced in the contralateral upper limb, but, since he was asymptomatic, detailed examinations for low-flow low-gradient aortic stenosis were scheduled after the surgery. On the third day after the surgery, he was urgently admitted to our hospital because of the development of acute heart failure. Even after admission, he remained refractory to heart failure treatment. Thus, it was difficult to perform dobutamine stress echocardiography examination to evaluate the severity of the disease, but he was finally diagnosed with severe aortic stenosis with a high aortic valve calcification score. He subsequently underwent surgical aortic valve replacement therapy, which improved his symptoms of heart failure. Low-flow low-gradient aortic stenosis is a condition in which the aortic valve flow rate and mean pressure gradient do not increase, and the severity of the condition is often underestimated. Since patients on hemodialysis show a high incidence of aortic stenosis, it is important to assess the severity of low-flow low-gradient aortic stenosis and treat it appropriately.</p>

A case of low-flow low-gradient aortic stenosis with repeated heart failure after arteriovenous fistula creation

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