Underestimation the severity of aortic stenosis in a patient undergoing lumbar spine surgery

Abstract

　A 71-year-old man was scheduled for lumbar spine surgery. Preoperative transthoracic echocardiography showed a calcified aortic valve with a valve area of 0.96 cm², and a mean pressure gradient of 27 mmHg. He diagnosed with asymptomatic, moderate aortic stenosis. The intraoperative course was uneventful, but the postoperative course was complicated by intractable heart failure. Aortic valve replacement was performed. Although he had ischemic heart disease, his intractable heart failure seemed to have been caused mainly by myocardial ischemia due to low-flow low-gradient severe aortic stenosis. The operative findings of severely calcified aortic leaflets were compatible with severe aortic stenosis. He had hemodialysis-dependent end-stage renal disease, chronic atrial fibrillation, and mitral regurgitation, and these comorbidities appeared to be associated with the underestimation of the severity of aortic stenosis on echocardiographic assessment. In addition, his cardiac symptoms could have been underestimated because of his limited activity, attributed to the pain from spinal stenosis.