A multiparous woman with lately diagnosed multilevel left ventricular obstruction

Muhammad Nasir Rahman, Ibrahim Gul, Amjad Nabi

Research output: Contribution to journalArticlepeer-review


A 56-year hypertensive, multiparous woman presented to the cardiology unit with Canadian Cardiovascular Society (CCS) class-III angina and worsening dyspnea for the past few weeks. Her clinical examination showed high blood pressure and mid-systolic crescendo-decrescendo murmur radiating to carotids. However, there was no radio-femoral delay or significant blood pressure difference between her arms. Her transthoracic echocardiography (TTE) revealed moderate aortic stenosis (AS) and mid cavity left ventricular outflow (LVO) obstruction. Left heart catheterization (LHC) showed coarctation of aorta with extensive collaterals, mid cavity LVO obstruction, and moderate AS. Thus, she was diagnosed as a case of multi-level LVO obstruction including mid cavity LVO obstruction AS and coarctation of aorta. She underwent stenting of aortic coarctation as the initial step of graded approach to her disease, and is doing well.

Original languageEnglish
Pages (from-to)305-307
Number of pages3
JournalJournal of the College of Physicians and Surgeons--Pakistan : JCPSP
Issue number5
Publication statusPublished - 1 May 2017


  • Bicuspid aortic valve
  • Canadian cardiovascular society
  • Coarctation of aorta
  • Computed tomographic angiography
  • Covered stent
  • Mid cavity. aortic stenosisLelt heart catheterization
  • Radio-femoral delay multilevel left ventricular obstruction


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