Hypertrophic obstructive cardiomyopathy with left ventricular outflow and mid obstruction with apical aneurysm: a case r
- PDF / 624,275 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 9 Downloads / 195 Views
CASE IMAGE IN CARDIOVASCULAR ULTRASOUND
Hypertrophic obstructive cardiomyopathy with left ventricular outflow and mid obstruction with apical aneurysm: a case report Ikuo Misumi1 · Koji Sato1 · Miwa Nagano1 · Yuriko Yamada2 · Joji Urata3 · Koichi Kaikita4 · Kenichi Tsujita4 Received: 17 May 2020 / Revised: 30 July 2020 / Accepted: 25 August 2020 © Japanese Society of Echocardiography 2020
A 91-year old woman with a fracture at the great trochanter in her left femur was brought to our hospital in an ambulance. She complained left femoral pain and chest discomfort. Her blood pressure was 158/85 mmHg and pulse rate was 77 beats per minute. Results from the blood analysis report showed dehydration by diuretic and high brain natriuretic peptide level of 1178 pg/mL. A chest radiography showed cardiothoracic ratio of 63% with mild pulmonary congestion. A two-dimensional transthoracic echocardiography showed left ventricular (LV) hypertrophy with normal systolic function (thickness of interventricular septum and posterior wall was 17 mm and 11 mm, each, LV end-diastolic dimension of 40 mm, end-systolic dimension of 19 mm, and ejection fraction of 70%). Left atrial volume index was 45.6 ml/m2. A pulsed Doppler echocardiography and a tissue Doppler echocardiography showed E/A ratio of 1.0 and E/e’ ratio of 39. There was a LV outflow tract obstruction (LVOTO) with moderate mitral regurgitation (Fig. 1a, b) [1]. A continuous-wave Doppler echocardiogram showed that the estimated peak pressure gradient was 128 mmHg at the LVOTO (Fig. 1c), 246 mmHg at the mitral regurgitation (Fig. 1d), and 28 mmHg at the tricuspid regurgitation. An
M-mode echocardiography showed systolic half closure of aortic valve by LVOTO (Fig. 1e) [2]. A color-flow imaging (Fig. 1f) and a pulsed-wave Doppler echocardiography (Fig. 1f) showed mid-ventricular obstruction with paradoxic jet flow of 1.9 m/s (Fig. 1g). A two-dimensional echocardiography (Fig. 1h) and a cardiac magnetic resonance imaging (C-MRI) showed small aneurysm at the apex (Fig. 1i, j). The diuretic was stopped and fluid infusion was initiated. Henceforth, the patient was administered 2.5 mg of bisoprolol and 100 mg of disopyramide [3]. After treatment, her chest discomfort disappeared and plasma BNP level decreased to 510 pg/mL. Furthermore, a follow-up echocardiography showed there was no significant LVOTO or mitral regurgitation (Fig. 1k). Without surgical operation, she was discharged our hospital on foot. A previous report showed that surgical myectomy or medical treatment for obstruction may decrease the rate of sudden cardiac death [4]. In the present case of severe LVOTO, combination therapy of disopyramide with bisoprolol extinguished LVTOT and MR, demonstrating improved symptom and laboratory data and possible prevention of sudden death.
* Ikuo Misumi [email protected] 1
Department of Cardiology, Kumamoto City Hospital, 4‑1‑60, Higashi‑machi, Higashi‑ku, Kumamoto City, Kumamoto 862‑8505, Japan
2
Department of Orthopedics, Kumamoto City Hospital, 4‑1‑60, Higash
Data Loading...
