case_images: PMC10929027_01
case_images: (a) pulsed doppler in the aortic valve showing severe AS (surface: 0.7 cm2); (b) continuous wave doppler showing severe AS (Vmax: 4.8 m/s, mean gradient: 53 mm Hg); (c) continuous wave doppler in the aortic valve showing moderate aortic insufficiency (PHT: 388 ms).. AS: aortic stenosis; PHT: Pressure Half Time.
case_images: 10.1177_2050313X241237405-fig1.jpg
case_images: PMC10929027_01_10.1177_2050313X241237405-fig1.jpg
case_images: fig1-2050313X241237405
case_images: After initial treatment with IV furosemide, transthoracic echocardiography showed severe aortic stenosis (AS) (aortic area: 0.9 cm2, mean gradient: 53 mm Hg, peak velocity: 4.8 m/s) (Figure 1) associated with moderate aortic regurgitation and severe tricuspid regurgitation (EROA: 0.6 cm2, RV: 98 ml) (EROA: Effective Regurgitant Orifice Area; RV: Regurgitant Volume) with a high probability of PH (systolic pulmonary artery pressure estimated at 95 mmHg on tricuspid regurgitation flow) (Figure 2).
case_images: (a-b) colour Doppler and continuous wave doppler in the tricuspid valve showing severe tricuspid insufficiency (EROA: 0.6 cm2, RV: 98 ml, Vmax: 4.62 m/s); (c) pulsed Doppler in the pulmonary valve showing the appearance of the mid systolic notch (red arrow) in favour of severe PH; (d) pulsed tissue doppler showing normal peak systolic velocity of tricuspid anulus (S'); (e) colour Doppler and continuous wave doppler in the tricuspid valve showing a reduction in severity of tricuspid insufficiency after euthyroidism (EROA: 0.4 cm2, RV: 66 ml, Vmax: 3.94 m/s).. PH: pulmonary hypertension.
case_images: 10.1177_2050313X241237405-fig2.jpg
case_images: PMC10929027_01_10.1177_2050313X241237405-fig2.jpg
case_images: fig2-2050313X241237405
case_images: After initial treatment with IV furosemide, transthoracic echocardiography showed severe aortic stenosis (AS) (aortic area: 0.9 cm2, mean gradient: 53 mm Hg, peak velocity: 4.8 m/s) (Figure 1) associated with moderate aortic regurgitation and severe tricuspid regurgitation (EROA: 0.6 cm2, RV: 98 ml) (EROA: Effective Regurgitant Orifice Area; RV: Regurgitant Volume) with a high probability of PH (systolic pulmonary artery pressure estimated at 95 mmHg on tricuspid regurgitation flow) (Figure 2). Left and right ventricular functions were preserved (Figure 2). After 3 months of treatment, the patient was euthyroid, and cardiac echocardiography showed a reduction in the PAPs value (Figure 2).
case_images: Thoracic computed tomography scan showing dilation of the pulmonary artery trunk and its branches (red arrows) without signs of chronic pulmonary embolism, right moderate pleurisy (green arrow), cardiomegaly, passive ventilation disorders of the right lower lobe (yellow arrow).
case_images: 10.1177_2050313X241237405-fig3.jpg
case_images: PMC10929027_01_10.1177_2050313X241237405-fig3.jpg
case_images: fig3-2050313X241237405
case_images: Right heart catheterization revealed mixed hypertension (mPAP: 54 mm Hg, sPAP: 94 mm Hg, PAWP: 28 mm Hg, PVR calculated at 7.2 WU), a chest computed tomography (CT) scan showed signs of PH but no signs of chronic pulmonary embolism (Figure 3), viral serologies (HIV, HBV, HCV) were negative, and D-dimer values were also normal.