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SEEING IS BELIEVING: UTILIZING MULTIPLE IMAGING MODALITIES IN DIFFICULT TO CHARACTERIZE LEFT VENTRICLE OUTFLOW OBSTRUCTION
2143 JACC March 21, 2017 Volume 69, Issue 11
FIT Clinical Decision Making SEEING IS BELIEVING: UTILIZING MULTIPLE IMAGING MODALITIES IN DIFFICULT TO CHARACTERIZE LEFT VENTRICLE OUTFLOW OBSTRUCTION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: FIT Clinical Decision‐Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1129-366 Authors: Sandeep Sangodkar, Alex Schevchuck, Kirsten Tolstrup, Abinash Achrekar, University of New Mexico, Albuquerque, NM, USA, University of California, San Francisco, San Francisco, CA, USA
Background: Left Ventricular Outflow Tract (LVOT) Obstruction can pose diagnostic challenges. Different imaging modalities may aid in the diagnosis.
Case: 62 year old female with longstanding diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) presented with worsening exertional dyspnea and chest pain. A cardiac catheterization demonstrated non-obstructive coronary artery disease, but a LVOT peak to peak gradient 70mmHg. Before disopyramide therapy, a transthoracic echocardiogram (TTE) was performed showing gradient along LVOT/ aortic valve axis by continuous wave Doppler but no evidence of HOCM, aortic valve stenosis, or structural cardiac abnormalities. Decision‐Making: A focused TTE was repeated without evidence of high LVOT gradient. A Cardiac MRI was remarkable for absence of typical MRI HOCM findings, but calculated LV/Ao pressure gradient was approximately 85mmHg. Due to conflicting data it was decided to pursue transesophageal echocardiogram, which demonstrated a muscular septal ridge versus thick subaortic membrane in LVOT with effective orifice area by 3D planimetry 0.78cm2. The sub-aortic obstruction was severe (peak and mean gradients 75 and 32 mm Hg, respectively). She was referred for surgical excision of subaortic membrane.
Conclusions: This case highlights LVOT gradient caused by a sub-aortic membrane not diagnosed by several imaging tests. Comprehensive assessment with different imaging modalities may be necessary to explain peculiar hemodynamic findings.
FIT Clinical Decision Making SEEING IS BELIEVING: UTILIZING MULTIPLE IMAGING MODALITIES IN DIFFICULT TO CHARACTERIZE LEFT VENTRICLE OUTFLOW OBSTRUCTION Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 10:00 a.m.-10:45 a.m. Session Title: FIT Clinical Decision‐Making: Non-Invasive Imaging and Valvular Heart Disease Abstract Category: Non Invasive Imaging Presentation Number: 1129-366 Authors: Sandeep Sangodkar, Alex Schevchuck, Kirsten Tolstrup, Abinash Achrekar, University of New Mexico, Albuquerque, NM, USA, University of California, San Francisco, San Francisco, CA, USA
Background: Left Ventricular Outflow Tract (LVOT) Obstruction can pose diagnostic challenges. Different imaging modalities may aid in the diagnosis.
Case: 62 year old female with longstanding diagnosis of hypertrophic obstructive cardiomyopathy (HOCM) presented with worsening exertional dyspnea and chest pain. A cardiac catheterization demonstrated non-obstructive coronary artery disease, but a LVOT peak to peak gradient 70mmHg. Before disopyramide therapy, a transthoracic echocardiogram (TTE) was performed showing gradient along LVOT/ aortic valve axis by continuous wave Doppler but no evidence of HOCM, aortic valve stenosis, or structural cardiac abnormalities. Decision‐Making: A focused TTE was repeated without evidence of high LVOT gradient. A Cardiac MRI was remarkable for absence of typical MRI HOCM findings, but calculated LV/Ao pressure gradient was approximately 85mmHg. Due to conflicting data it was decided to pursue transesophageal echocardiogram, which demonstrated a muscular septal ridge versus thick subaortic membrane in LVOT with effective orifice area by 3D planimetry 0.78cm2. The sub-aortic obstruction was severe (peak and mean gradients 75 and 32 mm Hg, respectively). She was referred for surgical excision of subaortic membrane.
Conclusions: This case highlights LVOT gradient caused by a sub-aortic membrane not diagnosed by several imaging tests. Comprehensive assessment with different imaging modalities may be necessary to explain peculiar hemodynamic findings.