Double envelope through the Aortic Valve
A 70-year-old man (99 kg, 185 cm) presented for aortic valve replacement due to severe calcific aortic valve stenosis (AS). His AS was recently diagnosed following investigation for pre-syncopal symptoms. Transthoracic echocardiogram demonstrated severe AS with peak and mean gradients of 84 and 48 mmHg, respectively. Asymmetric basal hypertrophy with mild left ventricular outflow tract (LVOT) obstruction were also noted. A peak LVOT gradient of 20 mmHg was measured with Valsalva maneuver, and mild mitral regurgitation was observed. After anesthetic induction, spectral Doppler profiles were obtained with transesophageal echocardiography in the deep transgastric window before cardiopulmonary bypass.