A Surgical Experience of Symptomatic Sigmoid Septum: Drastic Exacerbation of Mitral Regurgitation after Sufficient Ventricular Septal Myectomy

Autor: Kishu Fujita, Hisao Kumakura, Kuniki Nakashima, Kazutomo Minami
Rok vydání: 2014
Předmět:
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Biopsy
Cardiomegaly
Severity of Illness Index
Asymptomatic
Ventricular Outflow Obstruction
Risk Factors
Mitral valve
Internal medicine
Heart Septum
medicine
Humans
Ventricular outflow tract
cardiovascular diseases
Cardiac Surgical Procedures
Ventricular septal myectomy
Aged
Heart Valve Prosthesis Implantation
Mitral regurgitation
business.industry
Hemodynamics
Gastroenterology
Hypertrophic cardiomyopathy
Mitral Valve Insufficiency
General Medicine
medicine.disease
Sternotomy
Echocardiography
Doppler
Color
Surgery
Treatment Outcome
medicine.anatomical_structure
Ventricular Fibrillation
Ventricular fibrillation
Disease Progression
cardiovascular system
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
business
Atrioventricular block
Zdroj: Annals of Thoracic and Cardiovascular Surgery. 20:871-877
ISSN: 2186-1005
1341-1098
DOI: 10.5761/atcs.cr.13-00092
Popis: A 74-year-old woman presented with progressive dyspnea on exertion. Transthoracic echocardiography (TTE) demonstrated significant left ventricular outflow tract (LVOT) obstruction with a pressure gradient of 100 mmHg caused by a sigmoid septum (SS). Mitral regurgitation (MR) of a mild to moderate degree occurred due to systolic anterior motion (SAM) of the anterior mitral leaflet (AML), with no intrinsic mitral valve (MV) abnormality. Myectomy of the hypertrophied septal bulge ameliorated the pressure gradient to 8 mmHg with similar MR. However, just before the sternal closure, hemodynamic status deteriorated drastically to ventricular fibrillation. MR exacerbated to a severe degree with an uncertain etiology; thus, a mechanical prosthetic valve was implanted. The postoperative course was complicated by prolonged mechanical ventilation due to massive pulmonary edema and complete atrioventricular block (CAVB) requiring permanent pacemaker implantation. One year postoperatively, the patient is asymptomatic and TTE revealed no residual pressure gradient with an iatrogenic ventricular septal defect (VSD). This case, the first published surgical experience of SS, may indicate that secondary MR, which is usually relieved by sufficient myectomy in hypertrophic cardiomyopathy (HCM), can exacerbate markedly, and that myectomy might not be advisable in SS. The therapeutic strategy must be considered carefully before embarking on surgical intervention.
Databáze: OpenAIRE
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