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

Ranasinghe, Isuru; Yeoh, T.; Yiannikas, John

doi:10.1016/j.hlc.2011.05.002

Cited by 24 publications

(32 citation statements)

References 26 publications

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“…[1][2][3][4] The degree of LVOTO increases with provocation (e.g., exer cise or valsalva maneuver), and corresponds closely with the appearance of symptoms. 3,4) The mechanism of obstruction is thought to be similar to that in HCM. Complex interactions between the Venturi effect caused by flow acceleration around a hypertrophied septum and the drag effect caused by altered flow vectors within the LV to push the mitral valve (MV) into that LVOT are thought to be involved.…”

Section: Introductionmentioning

confidence: 95%

“…1,2) The local ized septal hypertrophy is attributed to an increase in connective tissue without myocyte disarray and the morphological appearance of the left ventricle (LV) and interventricular septum is distinctly different from that in typical hypertrophic cardiomyopathy (HCM) with otherwise normal septal and posterior wall dimen sions. [3][4][5] SS is basically considered to be an incidental finding associated with older age and hypertension, and of little clinical importance with a relatively benign prognosis. [3][4][5] However, it can be symptomatic with marked limitation of exercise tolerance, albeit rarely, by causing LVOT obstruction (LVOTO) accompanied by systolic anterior motion (SAM) of the anterior mitral leaflet (AML) and subsequent mitral regurgitation (MR), even in the absence of classical features of HCM.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] SS is basically considered to be an incidental finding associated with older age and hypertension, and of little clinical importance with a relatively benign prognosis. [3][4][5] However, it can be symptomatic with marked limitation of exercise tolerance, albeit rarely, by causing LVOT obstruction (LVOTO) accompanied by systolic anterior motion (SAM) of the anterior mitral leaflet (AML) and subsequent mitral regurgitation (MR), even in the absence of classical features of HCM. [1][2][3][4] The degree of LVOTO increases with provocation (e.g., exer cise or valsalva maneuver), and corresponds closely with the appearance of symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5] However, it can be symptomatic with marked limitation of exercise tolerance, albeit rarely, by causing LVOT obstruction (LVOTO) accompanied by systolic anterior motion (SAM) of the anterior mitral leaflet (AML) and subsequent mitral regurgitation (MR), even in the absence of classical features of HCM. [1][2][3][4] The degree of LVOTO increases with provocation (e.g., exer cise or valsalva maneuver), and corresponds closely with the appearance of symptoms. 3,4) The mechanism of obstruction is thought to be similar to that in HCM.…”

Section: Introductionmentioning

confidence: 99%

“…Complex interactions between the Venturi effect caused by flow acceleration around a hypertrophied septum and the drag effect caused by altered flow vectors within the LV to push the mitral valve (MV) into that LVOT are thought to be involved. 3) Preserved and often hyper contractile systolic function with a reduced LV cavity size might also have contributed. 4) Management of symptomatic LVOTO in SS has not been well established.…”

Section: Introductionmentioning

confidence: 99%

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

Fujita¹,

Nakashima²,

Kumakura³

et al. 2014

ATCS

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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.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Fujita¹,

Nakashima²,

Kumakura³

et al. 2014

ATCS

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Successful negative inotropic treatment of acute left ventricular outflow tract obstruction by elongated mitral valve leaflet

Ayoub

Ranasinghe

Yiannikas

2013

J of Clinical Ultrasound

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Elongated anterior mitral valve leaflet (EAMVL) has not been reported to cause left ventricular outflow tract obstruction (LVOTO) in the absence of left ventricular hypertrophy. We report the case of an elderly male patient who presented with acute heart failure and severe mitral regurgitation in the setting of dehydration. Echocardiography revealed acute LVOTO secondary to EAMVL. The patient was ineligible for surgery and was treated with negative inotropic agents, which ensured resolution of heart failure and marked improvement in the degree of LVOTO. This case demonstrates that, under certain circumstances, EAMVL without associated left ventricular hypertrophy may produce hemodynamic compromise that can be successfully treated medically.

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Right ventricular basal inflow and outflow tract diameters overestimate right ventricular size in subjects with sigmoid-shaped interventricular septum: a study using three-dimensional echocardiography

Okada

Kaga

Tsujita

et al. 2019

Int J Cardiovasc Imaging

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Purpose: Sigmoid-shaped ventricular septum (SS), a frequently encountered minor abnormality in echocardiographic examinations of the elderly, may have some influence on RV shape. We aimed to determine the influence of SS on the accuracy of the 6 RV linear diameter measurements in the light of three-dimensional echocardiographic (3DE) RV volume. Subjects and Methods: The aorto-septal angle (ASA) was measured in the parasternal long-axis view using two-dimensional echocardiography (2DE) as an index of SS in 70 patients without major cardiac abnormalities who were subdivided into 35 with SS (ASA ≤120 degree) and 35 without SS (NSS). We measured RV end-diastolic volume (RVEDV) using 3DE; in addition, using 2DE, we measured basal RV diameter, mid-cavity diameter, longitudinal diameter and end-diastolic area in the apical four-chamber view; proximal RV outflow tract (RVOT) diameter in the parasternal long-axis view; and proximal and distal RVOT diameters in the parasternal short-axis view. Results: RVEDV did not differ between the SS and NSS groups. The SS group had greater basal RV diameter and proximal and distal RVOT diameters than the NSS group. RV mid-cavity diameter, longitudinal diameter, and end-diastolic area did not differ between the groups. Among the 2DE parameters of RV size, RV end-diastolic area was most strongly correlated with RVEDV (r=0.67), followed by RV mid-cavity diameter (r=0.58). Conclusion: When SS is present, the echocardiographic basal RV diameter and RVOT diameters overestimate RV size, and the measurement of RV end-diastolic area and mid-cavity diameter more correctly reflect 3D RV volume.

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

Cited by 24 publications

References 26 publications

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

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

Successful negative inotropic treatment of acute left ventricular outflow tract obstruction by elongated mitral valve leaflet

Right ventricular basal inflow and outflow tract diameters overestimate right ventricular size in subjects with sigmoid-shaped interventricular septum: a study using three-dimensional echocardiography

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