Severe aortic stenosis can be accompanied by various degrees of left ventricular underdevelopment. The assessment whether a borderline-sized left ventricle can or cannot support the systemic circulation is crucial. The decision-making still remains challenging. We present a case that illustrates that the development of haemodynamic parameters can be difficult to estimate, even in the long term. The patient went from biventricular to univentricular circulation and back and could finally be palliated by heart transplantation. Modern technology including long-term mechanical cardiac support as a bridge to candidacy and drug therapy for pulmonary hypertension were vital to successfully combat a previously lethal disease.
Keywords: Aortic stenosis; Borderline left ventricle; Fontan circulation; Heart transplantation; Left ventricular assist device; Pulmonary hypertension.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.