Right-Sided Heart Failure Presentation in Severe Valvular Aortic Stenosis: How to Deal with Diuretic Use?

Introduction: Patients with right-sided heart failure and severe aortic stenosis (AS) have many clinical challenges to overcome fluid retention. A typical diuretic therapeutic approach can be recommended for the guidance of removing fluid overload in severe AS with right ventricular (RV) failure. This case review aims to understand how to assess and manage RHF and severe AS. Objective: This case report aims to describe of diuretic in Severe Valvular Aortic Stenosis Case Illustration: A 65-year-old female with worsening bilateral leg swelling, and she aware of the shortness of breath for three months. Physical examination revealed a grade 3/6 systolic ejection murmur at the aortic area radiating to the neck, a grade 2/6 diastolic murmur at the pulmonic area, and a grade 3/6 systolic murmur at the apex radiating to the axilla, increased jugular venous pressure, prominent bilateral leg swelling, and minimal rhonchi at the base of the lungs. The chest X-ray showed worsening cardiomegaly in the last three months. Echocardiography revealed high gradient severe valvular AS, decreased systolic RV function, high probability of pulmonary hypertension (PH), and other valvular dysfunctions, including moderate mitral regurgitation, moderate pulmonary regurgitation, and mild tricuspid regurgitation. She was introduced to high-dose furosemide infusion. The average urine output production was 5 L/day, and the negative fluid balance was 3 L/day. Furosemide dose was adjusted daily according to urine output production, and she was discharged after six days of hospitalization. Conclusion: This case report provides an example of RV failure in severe AS patients. Hemodynamic monitoring and the typical approach of diuretic therapies should be needed in the management of fluid overload in severe AS.