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

Abstract

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.

Effect of aortic regurgitant jet direction on mitral valve leaflet remodeling: a real-time three-dimensional transesophageal echocardiography study

“…Several studies also reported that long AML and a mismatch of AML/PML length were the predictors of SAM and LVOT obstruction in patients with LV hypertrophy 31 , 32 . Some reports 33 , 34 have described the possibility of LVOT obstruction in patients with large AML without LV hypertrophy in some situations, such as dehydration, during exercise, and inotropic treatment. Although most of patients with chronic AR have no concentric LV hypertrophy, patients with AML enlargement may suffered from LVOT obstruction in these situations.…”