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Case Reports
. 2010 May 5;2(2):e74-e77.
doi: 10.1016/j.jccase.2010.03.006. eCollection 2010 Oct.

Dynamic narrowing of left ventricular outflow tract-Possible mechanism of latent left ventricular outflow tract obstruction

Masaaki Shoji  1 , Tokuhisa Uejima  1 , Shunsuke Matsuno  1 , Yuji Oikawa  1 , Junji Yajima  1 , Takeshi Yamashita  1 , Akira Koike  1 , Hitoshi Sawada  1 , Mitsuaki Isobe  2 , Tadanori Aizawa  1
Affiliations
Case Reports

Dynamic narrowing of left ventricular outflow tract-Possible mechanism of latent left ventricular outflow tract obstruction

Masaaki Shoji et al. J Cardiol Cases. .

Abstract

It has been reported that left ventricular outflow tract (LVOT) obstruction can be provoked in patients even without significant left ventricular hypertrophy. We experienced a 74-year-old man with mild degree of left ventricular hypertrophy and latent LVOT obstruction which was successfully treated by alcohol septal ablation. LVOT was not narrow at end-diastole, but proximal septum was protruding further into LVOT during the ejection period, producing a dynamic narrowing of the LVOT. Alcohol septal ablation did not reduce the interventricular septal thickness nor enlarge LVOT. However, it limited the excursion of proximal septum. The effect of the treatment suggested the importance of the dynamic nature of LVOT in the mechanism of latent LVOT obstruction in this case.

Keywords: Alcohol septal ablation; Latent left ventricular outflow tract obstruction; Stress echocardiography.

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Figures

Figure 1
Figure 1
Comparison of left ventricular outflow tract (LVOT) features between before and after the alcohol septal ablation. (Before the procedure) (A) LVOT diameter; (B) angle of attack; (C) proximal septal thickness and bulge. (After the procedure) (D) LVOT diameter; (E) angle of attack; (F) proximal septal thickness and bulge.
Figure 2
Figure 2
Loss of dynamic narrowing of left ventricular outflow tract (LVOT) after alcohol ablation. The proximal septum was protruding further into LVOT and LVOT was narrowing from the onset of ejection (A) to the end of ejection (B). After the procedure, the proximal septum lost its excursion and LVOT was not significantly narrowing from the onset of ejection (C) to the end of ejection (D).
Figure 3
Figure 3
Simultaneous pressure curves of left ventricle and aorta.
See this image and copyright information in PMC

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