Left-Ventricular Outflow Tract Obstruction by Mitral Valve Ring Calcification and Proximal Septal Hypertrophy in Elderly Patients

Abstract

The pathophysiology, clinical presentation and prognosis of left-ventricular obstruction still represent an important cardiological problem. Various anatomical and/or functional mechanisms can cause this phenomenon. This report concerns 2 patients over 75 years old in whom the simultaneous presence of localized proximal septal hypertrophy and massive calcification in the anterior portion of the mitral valve ring provoked significant systolic intraventricular gradients. Cardiac rhythm disturbances and consequent variability of R-R intervals, found in both subjects, appear fundamental in determining the value of such gradients. Occasionally an anterior mitral ring calcification may bring about left-ventricular outflow tract obstruction in aged hearts where localized hypertrophy of the proximal portion of the intraventricular septum is present.

Negative Ionotropic Agents for the Treatment of Left Ventricular Outflow Tract Obstruction Due to Sigmoid Septum and Concentric Left Ventricular Hypertrophy

“…Concentric left ventricular hypertrophy (LVH) secondary to hypertensive heart disease and sigmoid septum (SS, also referred to as localised septal hypertrophy, septal bulge, septal knuckle or discrete upper septal hypertrophy) found amongst the elderly have been most commonly reported to cause resting LVOTO [4][5][6]. Additionally a number of uncommon conditions have rarely been found in association with Heart, Lung and Circulation Treatment of outflow tract obstruction in sigmoid septum and LVH (2011);20:579-586 resting LVOT obstruction including abnormality of papillary muscles [7], apical ballooning syndrome [8], mitral valve abnormalities [9] and cardiac amyloidosis [10]. Whilst negative ionotropes are of proven benefit in those with LVOTO in HCM, the role of these agents in the absence of typical hypertrophic features of HCM are uncertain with the present literature largely limited to isolated case reports.…”