HEMODYNAMICS CORNER Year : 2023  |  Volume : 24  |  Issue : 4  |  Page : 208-209  

An unusual hemodynamic pressure trace mimicking aortic stenosis: A decepti “Con”

Ankit Kumar Sahu, Kamlesh Raut, Sudeep Kumar, Aditya Kapoor
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission27-Feb-2023Date of Acceptance27-Aug-2023Date of Web Publication03-Nov-2023

Correspondence Address:
Dr. Aditya Kapoor
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow - 226 014, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/heartviews.heartviews_18_23

   Abstract 

We report an abnormal hemodynamic pressure tracing taken during pullback from the left ventricle. This report emphasizes the careful observation of hemodynamic tracing relative to continuous electrocardiographic monitoring for identifying potentially pathological vascular phenomena that may have detrimental outcomes on the clinical management of the underlying condition.

Keywords: Artifact, hemodynamic assessment, pullback pressure tracing

How to cite this article:
Sahu AK, Raut K, Kumar S, Kapoor A. An unusual hemodynamic pressure trace mimicking aortic stenosis: A decepti “Con”. Heart Views 2023;24:208-9
How to cite this URL:
Sahu AK, Raut K, Kumar S, Kapoor A. An unusual hemodynamic pressure trace mimicking aortic stenosis: A decepti “Con”. Heart Views [serial online] 2023 [cited 2023 Nov 17];24:208-9. Available from: https://www.heartviews.org/text.asp?2023/24/4/208/389337    Case Summary 

A 50-year-old male with atrial septal defect and moderate valvular pulmonary stenosis underwent cardiac catheterization study. A withdrawal pressure trace from the pulmonary artery to the right ventricle (RV) revealed a gradient of 50 mmHg at the pulmonary valve and an RV systolic pressure of 85 mmHg.

The systemic pressure trace taken during pullback from the left ventricle (LV) is depicted in [Figure 1]A. A casual observation of this pressure trace was interpreted as a gradient across the aortic valve.

Figure 1: Pressure trace is taken during pullback from the left ventricle (Panel A). Panel B shows the same tracing with “T” and “A” markings over different phases of the pullback pressure curve. “T” denotes true ventricular pressure traces while “A” represents the artifactual waveforms corroborated by a lack of electrocardiographic potential

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Hence, does the patient have aortic stenosis (AS)?

There is no AS since the pressure waveforms labeled a “T” are true ventricular pressure traces while the ones labeled as “A” are artifacts [Figure 1]B which is corroborated by the following facts:

The corresponding electrocardiogram (ECG) trace in the upper panel demonstrates that each ECG complex corresponds only to the pressure waveforms labeled a “T”The waveforms labeled as “A” do not have any accompanying ECG complexes, confirming them to be artifactsThe pressure waveforms (in green) reflect a simultaneous right atrial pressure trace.The so-called withdrawal trace depicted reveals an alternate (beat-to-beat) variation in the systolic pressure that was wrongly interpreted as an LV-to-aorta gradient. A true withdrawal trace cannot have alternate variation in systolic pressure as the withdrawal will usually demonstrate a smooth and sustained pressure drop from the high-pressure to the low-pressure chamber.    Conclusion 

Careful analysis of hemodynamic pressure tracings is often illustrative and helps avoid misinterpretation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

  [Figure 1]