Non-obstructive aortic angioscopy is an intravascular imaging modality applied to safely acquire real visible lightbased detailed images of the inner surface of the aortic lumen in vivo on a real-time basis, which are not well detected by other imaging modalities including computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound imaging. Application of this technique and usage in research and in clinical practice can be facilitated by the development of uniform standards of its methodology, interpretation, diagnosis, reporting, and terminology. The aim of this document is to make the output of the Working Group of Japan Vascular Imaging Research Organization for Standardization of Non-obstructive Aortic Angioscopy for the purpose of announcing the consensus standards for acquisition, measurement, and reporting of non-obstructive aortic angioscopy studies as version 2017.
A 56-year-old man was admitted to the hospital with episodes of shortness of breath and chest pain on effort immediately after standing. Physical examination revealed a systolic murmur at the left sternal border in the fourth intercostal space. Transthoracic cross-sectional echocardiography showed a sigmoid-shaped septum protruding markedly into the left ventricle. Treadmill exercise testing revealed no ischemic ST-T changes. Dobutamine stress echocardiography (DSE) resulted in left ventricular outflow tract obstruction (LVOTO) accompanying the chest symptoms. Latent LVOTO occurs rarely in cases of sigmoid-shaped septum, which are considered normal during the aging process. We conclude that we should pay attention to latent LVOTO among the causes of unexplained chest pain in patients with sigmoid-shaped septum, and that DSE is necessary to make the diagnosis of latent LVOTO.
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