Complex and multilevel left ventricular outflow tract obstruction: What can 3D echocardiography add?

Abstract

Background Subaortic obstruction by a membrane or systolic anterior motion of the mitral valve leaflets is usually suspected in young patients, especially if the anatomy of the aortic valve is not clearly stenotic and unexplained left ventricular hypertrophy exists in the context of high transaortic gradients. Main body In certain circumstances, some patients show both aortic and subaortic stenotic lesions of variable severity. Doppler echocardiography can help in grading severity in the case of single-level obstruction but not in patients with multilevel obstruction where the continuity equation is of no value. Three-dimensional (3D) echocardiography allows "en-face" visualization of each level of the aortic valve and subaortic tract; in addition, direct planimetry of the areas can be done using multiplanar reformatting. Conclusions Accordingly, 3D echocardiography plays a crucial role in the assessment in patients with multilevel left ventricular outflow tract obstruction as it can accurately delineate the location and size, and severity of the stenosis.

Imaging of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

“…Mitral valve chordal rupture has been reported with a subaortic membrane, mimicking SAM seen in HCM and further confusing the diagnosis [30]. 3D echocardiography is a valuable tool to accurately identify and differentiate between these overlapping pathologies [31].…”