Inappropriate left ventricular hypertrophy in minor aortic valve disease: a source of error in clinical assessment.

A group of patients with minor aortic valve disease and inappropriately severe left ventricular hypertrophy is described. Clinical, electrocardiographic and echocardiographic assessment of the degree of left ventricular hypertrophy suggested that they had haemodynamically severe aortic stenosis but this was not borne out at cardiac catheterisation. Although a chance association between non-obstructive hypertrophic cardiomyopathy and mild aortic stenosis may have been responsible, an abnormally severe hypertrophic response to minor aortic outflow obstruction is proposed as another possible explanation. The association between minor aortic valve disease and severe left ventricular hypertrophy should be considered when assessing aortic stenosis since the prognosis with medical management seems good and valve replacement is likely to be of no benefit in such cases.