Dynamic Left Ventricular Outflow Tract Obstruction in the Setting of Acute Myocardial Infarction

Liu, Shuo; Baribeau, Yanick; Ahmed, Andaleeb A.; Sharkey, Aidan; Chu, Louis M.; Mahmood, Feroze; Matyal, Robina

doi:10.1053/j.jvca.2019.06.032

Cited by 1 publication

(1 citation statement)

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“…Traditionally, dynamic left ventricular (LV) outflow tract (LVOT) obstruction (DLVOTO) without a fixed stenosis in the LVOT has been associated with hypertrophic obstructive cardiomyopathy (HOCM) [1]. However, DLVOTO has also been described in a number of other disease states such as following acute anterior wall myocardial infarction due to compensatory hyperkinesia of the basal parts of the LV myocardium [2], increased sympathetic activity and catecholamine secretion in pheochromocytoma, or in other conditions with increased myocardial contractility (use of inotropic agents), or acute Takotsubo syndrome [3]. DLVOTO may also occur as a consequence of the hyperdynamic contraction of the nonischemic regions of the LV myocardium in the presence of severe coronary artery obstruction.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Stress Echocardiography in Assessment of Dynamic Left Ventricular Obstructions: Case Series and Review of the Literature

Saeed

Vegsundvåg

2021

Cardiology

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Dynamic left ventricular outflow tract obstruction (DLVOTO) or midcavity obstruction in patients with structurally normal hearts is not uncommon in routine clinical practice and can cause significant symptoms mimicking coronary artery disease or heart failure. Although exercise echocardiography is the gold standard for assessing DLVOTO, dobutamine stress echocardiography (DSE) may be valuable diagnostic modality in patients who are unable to exercise or have an uninterpretable 12-lead electrocardiogram. We provide an updated overview of the relevant literature regarding prevalence, pathophysiology, clinical significance, and prognostic impact of DLVOTO and midcavity obstruction in structurally normal hearts. We also present a clinical series of 4 cases of DLVOTO and midcavity obstruction documented by DSE and discuss the value of different kinds of modern stress imaging modalities involving: (1) contrast-enhanced DSE to assess myocardial perfusion and inducible ischemia; (2) adenosine stress echocardiography to assess coronary flow reserve/microvascular dysfunction; and (3) functional imaging with deformation echocardiography to assess subclinical myocardial dysfunction in patients with structurally normal heart and without significant coronary disease. Based upon our own experiences and a critical review of the current literature, we will then present a practical guidance for management of DLVOTO and midcavity obstruction.

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Section: Introductionmentioning

confidence: 99%