Left Ventricular Outflow Tract Obstruction From Preserved Leaflet After Mitral Valve Replacement

Gulkarov, Iosif; Das, Mukund; Bronchard, Krystyna; Imam, Mohammed; Rosell, Frank; Lackey, Adam; Ramasubbu, Kumudha; Afzal, Ashwad

doi:10.1016/j.athoracsur.2019.10.074

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Bioprostheses implanted in the mitral position can reportedly cause LVOTO [ 6 , 7 , 10 , 11 ], especially in patients with a narrowed mitral-aortic angle, thickened interventricular septum, systolic anterior motion, small LV cavity, and atrial fibrillation [ 6 , 10 , 12 ]. The stent post of the bioprosthesis tends to protrude higher than the mechanical valve [ 7 , 10 , 11 ]; however, PH due to stent-post protrusion of the bioprosthetic mitral valve into the LVOT is rare [ 11 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Redo mitral valve replacement in an adult with severe pulmonary hypertension resulting from structural valve deterioration and left ventricular outflow tract obstruction and a history of atrioventricular septal defect repair: a case report

Sugiyama,

Matsuyama,

Ogino

2023

J Cardiothorac Surg

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Background Pulmonary hypertension (PH)-associated with left heart disease (Nice PH classification group II) improves when the latter is treated; however, the treatment of PH concomitant with group I PH due to congenital heart disease is difficult, and the optimal pharmacotherapy is controversial. Intervention strategies for the left-sided atrioventricular valve in partial atrioventricular septal defect (AVSD) are problematic. Case presentation A 37-year-old woman who had undergone patch closure for a partial AVSD and mitral valve replacement with a rather large bioprosthesis at the juxta-annular position for mitral regurgitation 12 years earlier was referred to our institute because of severe PH. Echocardiography revealed calcification resulting in severe stenosis of the bioprosthesis and protrusion of its stent post into the left ventricular outflow tract; therefore, redo mitral valve replacement at the supra-annular position was performed using a mechanical valve. Combined group I and II PH gradually improved with meticulous postoperative medical management. Conclusions Severe PH due to stent post protrusion and structural valve deterioration in AVSD was successfully treated with redo mitral valve replacement. The present case was complicated with group I and II PH, for which medical therapy in conjunction with surgical treatment yielded an optimal therapeutic effect.

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Section: Discussionmentioning

confidence: 99%

Redo mitral valve replacement in an adult with severe pulmonary hypertension resulting from structural valve deterioration and left ventricular outflow tract obstruction and a history of atrioventricular septal defect repair: a case report

Sugiyama,

Matsuyama,

Ogino

2023

J Cardiothorac Surg

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“…The late presentation with LVOTO 5 years following insertion of mitral bioprosthesis with full retention of the AML has been reported. 9 The late systolic gradient peak in patients with hypertrophic cardiomyopathy is usually due more to myocardial narrowing of the LVOT rather than to SAM. In hypertrophic cardiomyopathy, SAM is initiated in early systole, but the LVOTO can become significant at any time during systole.…”

Section: Discussionmentioning

confidence: 99%

“… 1 Other cases in which valve replacement without resection of the AML-induced severe LVOTO have been reported. 2 , 9 , 12 The prevention of LVOTO can be achieved by modification of the AML or modification of the bioprosthetic valve design. Modification of the AML to prevent LVOTO can be achieved by rectangular resection of the midportion of the leaflet with minimal resection of chordae and no other native valve modification.…”

Section: Discussionmentioning

confidence: 99%

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Bioprosthetic interstrut distance subtending the preserved anterior mitral leaflet mitigates left ventricular outflow tract obstruction

et al. 2021

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Analysis of Echocardiographic and Mri Anatomical Characteristics and Hemodynamic Characteristics of Left Ventricular Outflow Tract Stenosis

Wang

Song

et al. 2021

J. Mech. Med. Biol.

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Objective: To analyze the anatomical morphological and hemodynamic characteristics of left ventricular outflow tract stenosis (LVOTS) by echocardiography and MRI. Methods: The Echocardiography data of 112 patients with LVOTS were retrospectively analyzed by measuring the basal interventricular septal thickness (IVST-b), the left ventricle posterior wall thickness (LVPWT), and the peak pressure gradient of LVOTS, as well as by observing the characteristics of spectral pattern and the presence of systolic anterior motion of mitral valve leaflets. A Siemens 3.0T MRI scanner was used to scan the contrast-enhanced left ventricular (LV) volume of all cases. The obtained end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) of LV were compared with the Echocardiography results. Results: The 112 patients were divided into four groups: hypertrophic obstructive cardiomyopathy (Group I, 42 cases), hypertensive left ventricular hypertrophy (Group II, 40 cases), basal septal hypertrophy in the elderly (Group III, 21 cases), and the subaortic membrane (Group IV, 9 cases). The continuous wave (CW) Doppler characteristic of Groups I, II, and III was broadsword-shaped jet, and that of Group IV was equilateral triangle-like spectrum. The IVST-b, IVST-b/LVPWT ratio and peak pressure gradient of LVOTS of Group I was significantly higher than those in Groups II and III ([Formula: see text]). The LVPWT of the first three groups was slightly correlated with the LVOTS peak pressure gradient ([Formula: see text], respectively, [Formula: see text]). There were no statistically significant differences between Echocardiography and MRI results regarding the LV EDV, ESV, SV, and EF ([Formula: see text]), and no statistically significant differences were found between Echocardiography and MRI results regarding the myocardial thicknesses of septal, anterior, lateral, and inferior walls ([Formula: see text]). The Pearson’s correlation analysis demonstrated correlations between MRI and Echocardiography results for LV EDV, ESV, SV, and EF ([Formula: see text], 0.002, 0.009, and [Formula: see text], respectively). The MRI enhancement was shown as delayed enhancement in 52 cases, localized enhancement in 8 cases, diffuse enhancement in 6 cases, and transmural enhancement in 3 cases, with abnormal enhancement lesions distributed in the area of ventricular septum free wall junctions and ventricular septum. Conclusion: Using MRI to evaluate LV function of hypertrophic cardiomyopathy is reliable and accurate. MRI enhancement can be used for the quantitative measurement of myocardial fibrosis. Echocardiography can distinguish the stenosis types of LVOTS. The IVST-b and existence of SAM may be important anatomical characteristics determining the degree of dynamic stenosis, and MRI combined with Echocardiography can provide important detailed information.

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Left Ventricular Outflow Tract Obstruction From Preserved Leaflet After Mitral Valve Replacement

Cited by 4 publications

References 5 publications

Redo mitral valve replacement in an adult with severe pulmonary hypertension resulting from structural valve deterioration and left ventricular outflow tract obstruction and a history of atrioventricular septal defect repair: a case report

Redo mitral valve replacement in an adult with severe pulmonary hypertension resulting from structural valve deterioration and left ventricular outflow tract obstruction and a history of atrioventricular septal defect repair: a case report

Bioprosthetic interstrut distance subtending the preserved anterior mitral leaflet mitigates left ventricular outflow tract obstruction

Analysis of Echocardiographic and Mri Anatomical Characteristics and Hemodynamic Characteristics of Left Ventricular Outflow Tract Stenosis

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