Sudden Development of Intraoperative Left Ventricular Outflow Obstruction: Differential and Mechanism. An Intraoperative Two-Dimensional Echocardiographic Study
| Autor: | Heidi K. Krenz, Theresa Guarino, Martin E. Goldman, Bruce P. Mindich |
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| Rok vydání: | 1990 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty medicine.medical_treatment Cardiac Output Low Heart Valve Diseases Ventricular outflow tract obstruction Ventricular Outflow Obstruction Monitoring Intraoperative Mitral valve Internal medicine Mitral valve annuloplasty medicine Humans Ventricular outflow tract cardiovascular diseases Systole Intraoperative Complications Aged Aged 80 and over Mitral valve repair Mitral regurgitation Blood Volume business.industry Hypertrophic cardiomyopathy Calcinosis Mitral Valve Insufficiency Prostheses and Implants Middle Aged medicine.disease medicine.anatomical_structure Echocardiography cardiovascular system Cardiology Mitral Valve Female Surgery Radiology medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiac Surgery. 5:93-101 |
| ISSN: | 1540-8191 0886-0440 |
| DOI: | 10.1111/j.1540-8191.1990.tb00745.x |
| Popis: | Systolic anterior motion (SAM) of the mitral valve, once considered to be pathognomonic of hypertrophic cardiomyopathy, has been reported in the absence of asymmetric septal hypertrophy. Of the 1,000 open heart operations performed with intraoperative two-dimensional epicardial echocardiography monitoring, four patients developed intraoperative dynamic left ventricular outflow obstruction associated with systolic anterior motion of the mitral valve that was not present preoperatively: three cases of mitral valve annuloplasty with Carpentier ring insertion and one of coronary artery bypass grafting. Though no patient had asymmetric septal hypertrophy or echocardiographic evidence of outflow obstruction by either preoperative cardiac catheterization or echocardiography, intraoperative two-dimensional epicardial echocardiography revealed SAM, and hyperdynamic left ventricles with three of these patients having documented left ventricular outflow tract gradients causing hemodynamic compromise. (Case 4 was hemodynamically stable following mitral valve repair, but had SAM and significant residual mitral regurgitation [MR] requiring reinstitution of cardiopulmonary bypass and re-repair). Measurement of mitral annular dimension demonstrated a normal decrease in size from diastole to systole in control operative subjects but not in the patients who developed outflow obstruction. The pathophysiology, treatment, and role of intraoperative echocardiography of dynamic left ventricular outflow tract obstruction are discussed. |
| Databáze: | OpenAIRE |
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