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Case Reports
. 2021 Jun 16;3(6):871-874.
doi: 10.1016/j.jaccas.2021.04.035. eCollection 2021 Jun.

Dynamic Left Ventricular Outflow Tract Obstruction Post-Transcatheter Aortic Valve Replacement

Hellmuth S vH Weich  1 , Thadathilankal-Jess John  1 , Lloyd Joubert  1 , Jane Moses  1 , Philip Herbst  1 , Anton Doubell  1
Affiliations
Case Reports

Dynamic Left Ventricular Outflow Tract Obstruction Post-Transcatheter Aortic Valve Replacement

Hellmuth S vH Weich et al. JACC Case Rep. .

Abstract

We describe the first case of successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing. The possible mechanisms of obstruction resolution are described. (Level of Difficulty: Advanced.).

Keywords: HCM, hypertrophic cardiomyopathy; HOCM, hypertrophic obstructive cardiomyopathy; LVH, left ventricular hypertrophy; LVOT, left ventricular outflow tract; LVOTO, left ventricular outflow tract obstruction; SAM, systolic anterior motion of the mitral valve; SAVR, surgical aortic valve replacement; TAVR, transcatheter aortic valve replacement; aortic valve; cardiomyopathy; pacemaker; valve replacement.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Doppler Tracing Through Left Ventricular Outflow Tract (A) Apical 5-chamber continuous-wave Doppler tracing through the left ventricular outflow tract demonstrating the typical dagger-shaped pattern of dynamic left ventricular outflow tract obstruction. (B) After pacing, the gradient is significantly reduced.
Figure 2
Figure 2
Suggested Mechanism of Action of RV Pacing to Reduce LVOTO (A) After transcatheter aortic valve replacement, the sudden reduction in left ventricular pressures reducing cross-sectional area of the left ventricular outflow tract and increasing flow across the aortic valve causes a Venturi-like effect on the mitral valve, with resultant dynamic left ventricular outflow tract obstruction (LVOTO). (B) With right ventricular (RV) pacing, pacing-induced left-bundle branch block type activation results in paradoxical motion of the septum away from the mitral valve leaflet with a reduction in LVOTO. PL = pacing lead.
See this image and copyright information in PMC

References

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