Hemodynamic Evaluation of Concomitant Aortic Stenosis and Hypertrophic Obstructive Cardiomyopathy With Pressure Wire

Concomitant aortic stenosis (AS) and hypertrophic obstructive cardiomyopathy (HOCM) pose significant diagnostic and therapeutic challenges due to overlapping hemodynamic features. We present a case of an 89-year-old woman with severe AS and suspected LVOT obstruction, where imaging modalities were inconclusive. Invasive hemodynamic assessment using a pressure wire enabled precise differentiation and quantification of AS and LVOT gradients, including response to premature ventricular contractions. Based on these findings, alcohol septal ablation was performed before transcatheter aortic valve replacement (TAVR), resulting in improved hemodynamics and enabling safe TAVR. This case highlights the clinical value of pressure wire techniques for refined hemodynamic assessment and procedural planning in patients with dual pathology.