Paradoxical low-flow, low-gradient severe aortic stenosis with mild aortic valve calcification

Figure 1. Echocardiography before and after DSE and fluoroscopic images. A) Transthoracic echocardiography suggesting a hypertrophied, small ventricle. B) Continuous wave Doppler echocardiogram showing moderate aortic stenosis (mean pressure gradient 26 mmHg, peak jet velocity 3.2 m/s). C) & D) Echocardiogram showing mild mitral stenosis. E) & F) Computed tomography showing a low calcium burden (calcium volume: 82.4 mm3) with significantly thickened leaflets (G & H). I) Peak jet velocity and mean pressure gradient increased to 4.5 m/s and 43 mmHg, respectively after DSE. DSE: dobutamine stress echocardiography

A 71-year-old male was admitted to our hospital for chest distress and dyspnoea. ...