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Hypertrophic cardiomyopathy with dynamic obstruction and high left ventricular outflow gradients associated with paradoxical apical ballooning.
Sherrid, Mark V; Riedy, Katherine; Rosenzweig, Barry; Ahluwalia, Monica; Arabadjian, Milla; Saric, Muhamed; Balaram, Sandhya; Swistel, Daniel G; Reynolds, Harmony R; Kim, Bette.
Afiliación
  • Sherrid MV; Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Riedy K; Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Rosenzweig B; Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Ahluwalia M; Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Arabadjian M; Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Saric M; Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Balaram S; Mount Sinai St. Luke's, Icahn School of Medicine at Mount Sinai, New York City, New York.
  • Swistel DG; Hypertrophic Cardiomyopathy Program, Division of Cardiac Surgery, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Reynolds HR; Hypertrophic Cardiomyopathy Program, Division of Cardiology, New York University Langone Health, New York University School of Medicine, New York City, New York.
  • Kim B; Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, New York.
Echocardiography ; 36(1): 47-60, 2019 01.
Article en En | MEDLINE | ID: mdl-30548699
BACKGROUND: Acute left ventricular (LV) apical ballooning with normal coronary angiography occurs rarely in obstructive hypertrophic cardiomyopathy (OHCM); it may be associated with severe hemodynamic instability. METHODS, RESULTS: We searched for acute LV ballooning with apical hypokinesia/akinesia in databases of two HCM treatment programs. Diagnosis of OHCM was made by conventional criteria of LV hypertrophy in the absence of a clinical cause for hypertrophy and mitral-septal contact. Among 1519 patients, we observed acute LV ballooning in 13 (0.9%), associated with dynamic left ventricular outflow tract (LVOT) obstruction and high gradients, 92 ± 37 mm Hg, 10 female (77%), age 64 ± 7 years, LVEF 31.6 ± 10%. Septal hypertrophy was mild compared to that of the rest of our HCM cohort, 15 vs 20 mm (P < 0.00001). An elongated anterior mitral leaflet or anteriorly displaced papillary muscles occurred in 77%. Course was complicated by cardiogenic shock and heart failure in 5, and refractory heart failure in 1. High-dose beta-blockade was the mainstay of therapy. Three patients required urgent surgical relief of LVOT obstruction, 2 for refractory cardiogenic shock, and one for refractory heart failure. In the three patients, surgery immediately normalized refractory severe LV dysfunction, and immediately reversed cardiogenic shock and heart failure. All have normal LV systolic function at 45-month follow-up, and all have survived. CONCLUSIONS: Acute LV apical ballooning, associated with high dynamic LVOT gradients, may punctuate the course of obstructive HCM. The syndrome is important to recognize on echocardiography because it may be associated with profound reversible LV decompensation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cardiomiopatía Hipertrófica / Obstrucción del Flujo Ventricular Externo / Hipertrofia Ventricular Izquierda / Disfunción Ventricular Izquierda / Ventrículos Cardíacos Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Echocardiography Asunto de la revista: CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Cardiomiopatía Hipertrófica / Obstrucción del Flujo Ventricular Externo / Hipertrofia Ventricular Izquierda / Disfunción Ventricular Izquierda / Ventrículos Cardíacos Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: Echocardiography Asunto de la revista: CARDIOLOGIA / DIAGNOSTICO POR IMAGEM Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos