Type II myocardial infarction and latent LVOT obstruction due to Systolic Anterior Motion of mitral valve
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Abstract
Left ventricular outflow tract obstruction is a well-recognized feature in hypertrophic cardiomyopathy but can occur in other clinical scenarios when anatomically susceptible heart is subjected to permissive physiological conditions that provoke systolic anterior motion of the mitral valve (SAM): ie, reduced preload, increased inotropic state, and decreased afterload.
This report describes a case of hemodynamically significant latent LVOTO that was associated with hypotension, syncope, acute myocardial ischemic ECG changes, and an increase in cardiac enzymes. (Type II myocardial infarction) in a non HCM patient with excessive anterior mitral valve tissue.
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Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, et al. Stress Echocardiography Expert Consensus Statement: Executive Summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J. 2009; 30: 278–289. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19001473
Carpentier A, Adams DH, Filsoufi F. Carpentier’s Reconstructive Valve Surgery. Chapter 15. Maryland Heights: Saunders Elsevier, 2010. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363100/
Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002; 287: 1308-1320. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11886323
Fujita Y, Kagiyama N, Sakuta Y, Tsuge M. Sudden hypoxemia after uneventful laparoscopic cholecystectomy: another form of SAM presentation. BMC Anesthesiol. 2015; 15: 51. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25927407
Routledge T, Nashef SA. Severe mitral systolic anterior motion complicating aortic valve replacement. Interact Cardiovasc Thorac Surg. 2005; 4: 486–487. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17670463
Dorfman TA, Iskandrian AE, Aqel R. An unusual manifestation of Takotsubo cardiomyopathy. Clin Cardiol. 2008; 31: 194–200. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17847035
Maraud L, Gin H, Roudaut R, Aubertin J, Bricaud H. Echocardiographic study of left ventricular function in type 1 diabetes mellitus: hypersensitivity of beta-adrenergic stimulation. Diabetes Res Clin Pract. 1991; 11: 161–168. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2036938
Henein MY, O’Sullivan C, Sutton GC, Gibson DG, Coats AJ. Stress-induced left ventricular outflow tract obstruction: a potential cause of dyspnea in the elderly. J Am Coll Cardiol. 1997; 30: 1301–1307. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9350931
Ibrahim M, Rao C, Ashrafian H, Chaudhry U, Darzi A, Athanasiou T. Modern management of systolic anterior motion of the mitral valve. Eur J Cardiothorac Surg. 2012; 41: 1260–1270. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22290892
Pellikka PA, Oh JK, Bailey KR, Nichols BA, Monahan KH, Tajik AJ. Dynamic intraventricular obstruction during dobutamine stress echocardiography: A new observation. Circulation. 1992; 86: 1429–1432. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1423956
Luria D, Klutstein MW, Rosenmann D, Shaheen J, Sergey S, et al. Prevalence and significance of left ventricular outflow gradient during dobutamine echocardiography. Eur Heart J. 1999; 20: 386–392. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10206385
Barletta G, Del Bene MR, Gallini C, Salvi S, Costanzo E, et al. The clinical impact of dynamic intraventricular obstruction during dobutamine stress echocardiography. Int J Cardiol. 1999; 70: 179–189. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10454307
Haley JH, Sinak LJ, Tajik AJ, Ommen SR, Oh JK. Dynamic left ventricular outflow tract obstruction in acute coronary syndromes: an important cause of new systolic murmur and cardiogenic shock. Mayo Clin Proc. 1999; 74: 901–906. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/10488794
Luckner G, Margreiter J, Jochberger S, Mayr V, Luger T, et al. Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction: three cases of acute perioperative hypotension in noncardiac surgery. Anesth Analg. 2005; 100: 1594–1598. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15920179
Doi YL, McKenna WJ, Oakley CM, Goodwin JF. ‘Pseudo’ systolic anterior motion in patients with hypertensive heart disease. Eur Heart J. 1983; 4: 838–845. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/6686523
Freeman WK1, Schaff HV, Khandheria BK, Oh JK, Orszulak TA, et al. Intraoperative evaluation of mitral valve regurgitation and repair by transesophageal echocardiography: incidence and significance of systolic anterior motion. J Am Coll Cardiol. 1992; 20: 599-609. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/1512339
He S, Hopmeyer J, Lefebvre XP, Schwammenthal E, Yoganathan AP, et al. Importance of leaflet elongation in causing systolic anterior motion of the mitral valve. J Heart Valve Dis. 1997: 6: 149-159. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9130123
Shah PM, Raney. Echocardiographic correlates of left ventricular outflow obstruction and systolic anterior motion following mitral valve repair. J Heart Valve Dis. 2001; 10: 302-306. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/11380091
Grossi EA, Galloway AC, Kallenbach K, Miller JS, Esposito R, et al. Early results of posterior leaflet folding plasty for mitral valve reconstruction. Ann Thorac Surg. 1998; 65: 1057-1059. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/9564927