A 55-year-old man presents with lower extremity edema, orthopnea, and shortness of breath on exertion. On echocardiography, the left ventricular ejection fraction is approximately 15%, and the aortic valve is thickened with restricted leaflet excursion.

The mean gradient across the valve is 25 mmHg with a calculated valve area of 0.8 cm 2 . *This Case Challenge is from the Editorial team of Docplexus and is meant for educative purposes only.