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Recurrent Unilateral Transudative Pleural Effusion Due to Low Flow, Low Gradient Severe Aortic Stenosis

Jaafar F. Al-Khafaji, Mohamed Taha, Abubaker O. Abdalla, Christopher Rowan

(Department of Internal Medicine, University of Nevada, Reno, NV, USA)

Am J Case Rep 2018; 19:739-743

DOI: 10.12659/AJCR.909448

BACKGROUND: In symptomatic severe aortic stenosis (AS), the majority of patients have high gradient AS. However, some patients have an AS gradient less than 40 with a valve area under 1.0 cm². For patients with a low gradient, severe AS is difficult to detect and requires a high index of suspicion. Transcatheter aortic valve replacement (TAVR) is currently recommended for patients with moderate to high risk AS according to the Society of Thoracic Surgery (STS) risk score.
CASE REPORT: Here we present the case of an 86-year-old female with recurrent pleural effusion over the course of 2-year; she had multiple thoracentesis procedures and was being considered for a pleurodesis. Later the patient was found to have severe AS; an echocardiogram showed an aortic valve (AV) area of 0.67 cm², AV mean gradient of 34 mmHg, and ejection fraction of 75%. The patient underwent a diagnostic cardiac catheterization and was treated with TAVR.
CONCLUSIONS: The diagnosis was made after exclusion of all other causes of unilateral pleural effusion and was confirmed by improvement of effusion following the TAVR procedure.

Keywords: Aortic Valve Stenosis, Dyspnea, Pleural Effusion

This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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