Correction of left ventricular outflow tract obstruction caused by anomalous papillary muscle and subaortic membrane

Abstract This paper presents a case study of a 30-year-old male patient with dyspnea on exertion had echocardiographic diagnosis of aortic subvalvar stenosis. Discrete mitral regurgitation and aortic valve dysplasia with mild to moderate insufficiency and hypertrophic cardiomyopathy were also noted. During surgery, a rare condition was identified: presence of papillary muscle anomaly associated with the subaortic membrane as a cause of obstruction of the left ventricular outflow tract. With the resection of these structures and a mitral valve annuloplasty, the patient evolved with a significant improvement of clinical condition and heart failure, with no residual mitral insufficiency.

Extreme septal hypertrophy in an adolescent with congenital familial hypertrophic cardiomyopathy

No abstract available.

Giant ventricular myxoma obstructing right ventricular outflow tract / Mixoma ventricular direito gigante obstruindo via de saída do ventrículo direito

Intracardiac myxoma is predominantly located in the left atrium but their location in the right ventricle is quite unusual. We present a case in which successful excision of the tumor was done through bicameral approach.

Mixoma intracardíaco localiza-se predominantemente no átrio esquerdo, e sua localização no ventrículo direito é bastante incomum. Apresentamos um caso no qual excisão bem sucedida do tumor foi feita por meio de abordagem bicameral.

Surgical Management of Left Ventricular Outflow Tract Obstruction after Biventricular Repair of Double Outlet Right Ventricle

Regardless of the preoperative morphology and the type of operation, left ventricular outflow tract obstruction (LVOTO) after biventricular repair of double outlet right ventricle (DORV) may develop. This report presents our 10-yr experience with surgical management of LVOTO after biventricular repair of DORV. Between 1996 and 2006, 15 patients underwent reoperation for subaortic stenosis after biventricular repair of DORV. The mean age at biventricular repair was 23.3+/-18.3 months (1.1-64.2). Biventricular repairs included tunnel constructions from the left ventricle to the aorta in 14 cases and an arterial switch operation in one. The mean left ventricle-to-aorta peak pressure gradient was 54.0+/-37.7 mmHg (15-140) after a mean follow-up of 9.5+/-6.3 yr. We performed extended septoplasty in nine patients and fibromuscular resection in six. There were no early or late mortality. There was one heart block and one aortic valve injury after an extended septoplasty, and two and one after a fibromuscular resection. No patient required reoperation for recurrent subaortic stenosis. The mean pressure gradient was 11.2+/-11.4 mmHg (0-34) after a mean follow-up of 5.6+/-2.7 yr. Extended septoplasty is a safe and effective method for the treatment of subaortic stenosis, especially in cases with a long-tunnel shaped LVOTO.

Univentricular heart: management options.

The term ''Univentricular Heart'' encompasses a wide variety of heart defects that functionally and physiologically constitute a single ventricular chamber. The terminology ''univentricular repair'' is frequently used in the surgical literature to include those biventricular hearts that are not amenable for a final two ventricle repair and need to go through the same surgical stages as with a functionally univentricular heart, culminating finally in a total cavo-pulmonary connection. Broadly, treatment is focused on controlling the pulmonary blood flow in early infancy, by means of aorto-pulmonary shunting in pulmonary atresia or stenosis, and pulmonary artery banding or pulmonary artery disconnection with aorto-pulmonary shunt placement in high pulmonary blood flow situations. Concomitant repair of other associated conditions is required. Babies with hypoplastic left heart physiology undergo staged "Norwood" repair resulting in an eventual total cavo-pulmonary connection with the RV functioning as the systemic ventricle. In this review, medical and surgical management of these patients will be discussed, after a brief discussion of nomenclature, anatomic and physiologic considerations.

Infarto miocárdico inferior e choque associado a obstrução da via de saída do ventrículo esquerdo / Inferior myocardial infarction and shock associated with left ventricular outflow tract obstruction

Relatamos o caso de um paciente admitido no setor de emergência do nosso serviço com infarto agudo do miocárdio em parede inferior, submetido a angioplastia primária, complicado com choque não responsivo a administração de catecolaminas e a balão de contrapulsação intra-aórtico. A utilização do ecocardiograma transesofágico foi crucial na demonstração da movimentação sistólica anterior da valva mitral obstruindo a via de saída do ventrículo esquerdo.

Unruptured sinus of valsalva aneurysm presenting as acute coronary syndrome.

An unusual presentation of sinus of Valsalva aneurysm causing right ventricular outflow tract obstruction and presenting as acute coronary syndrome is reported. A 38-year-old lady presented with ischemic chest pain, probably due to embolization from an unruptured sinus of Valsalva aneurysm.

Obstrucción en las vÝas de salida en la transposición completa de las grandes arterias / Obstruction of outflow tracts in complete transposition of great arteries

The obstructive lesions in the outflow tracts of hearts with complete transposition of the great arteries determine the clinical evolution, prognosis, and the selection of surgical procedures. Their knowledge is basic to interpret the imaging findings. From the pathologic specimens collection of the Instituto Nacional de CardiologÝa "Ignacio Chßvez", seventy-tree hearts with this cardiopathy were studied morphologically with the sequential segmental system. Thirty-two hearts had outflow tracts anomalies, being obstructive twenty-eight; among these lesions were: malposition of the infundibular septum, hipertrophyc left infundibulum, prolapse of tricuspid valve tissue through a ventricular septal defect, accessory mitral valve tissue, septal hipertrophy at the left outflow tract level, abnormal insertion of cord tendinae of the mitral valve, anticlockwise malposition of the mitral valve (first report in the literature). The left outflow tract presented obstructive lesions (92.85) more frequently than the right one. These lesions produce left ventricular hipertrophy, a fundamental feature for the anatomic surgical procedures to be made.

Extensäo cardíaca de seminoma primário do mediastino, comprimindo a via do ventrículo direito / Cardiac extension of primary mediastinal seminoma compressing the right ventricular outflow tract

We report the case of a 33-year-old male with primary seminoma of the anterior mediastinum with initial clinical manifestations suggestive of heart disease

Divertículos de la valva anterior mitral como causa de obstrucción del tracto de salida del ventrículo izquierdo

Hombre de 35 años quien consultó por disnea progresiva de 6 meses de evolución. El ecocardiograma transesofágico mostró obstrucción del tracto de salida del ventrículo izquierdo por probable membrana subaórtica. En cirugía se encontraron dos formaciones saculares (divertículos) en la válvula mitral; el mayor de ellos protruía por el tracto de salida del ventrículo izquierdo causando obstrucción. Se practicó extirpación de la válvula con sus divertículos y se colocó prótesis mecánica

Left ventricular outflow tract obstruction due to a left ventricular myxoma: a case report and review of the literature.

A 17-year-old-man who presented with syncope, had a left ventricular (LV) myxoma causing left ventricular outflow tract obstruction. The tumor was removed through left ventriculotomy using conventional cardiopulmonary bypass with good result. There have been 47 cases of LV myxoma reported in the world literature since 1957. Most of them are symptomatic (92.7%). Systemic embolism is the most common manifestation (50%) and often leads to death. The surgical removal should be performed urgently. Resection of the mass with limited normal tissue surrounding its pedicle is recommended. There are only three recurrences and five operative deaths.

Sites of right ventricular outflow tract obstruction in tetralogy of Fallot--a retrospective study.

Fifty one angiographically proved cases of tetralogy of Fallot (TOF) in the age group of 5-50 years were analysed retrospectively for the level(s) of right ventricular outflow tract (RVOT) obstruction. Mean age was 18.1 +/- 11 yrs. Subvalvular stenosis was found to be the commonest site of RVOT obstruction in 49 (96.1%) patients. Evidence of valvular pulmonary stenosis was seen quite commonly (42/51, 83.9% cases), mostly in association with obstruction at other sites. Supravalvular stenosis was also seen in 17 (33.3%) cases. Higher incidence of pulmonary valvular involvement in patients with TOF, in higher average age of patient population may represent valvular involvement to be an acquired phenomenon.

Diagnóstico ecocardiográfico de folheto acessório de valva mitral / Accessory mitral valve leaflet echocardiographic diagnosis

O folheto acessório de valva mitral, rara anomalia congênita; geralmente associada a malformaçöes congênitas cardíacas complexas, é causa também rara de obstruçäo a via de saída do ventrículo esquerdo. Seu diagnóstico tem sido ignorado com muita freqüência pelos métodos complementares convencionais, o que pode ser causa de insucessos cirúrgicos de cardiopatias complexas. A ecoDopplercardiografia é método inedispensável e preciso para o seu diagnóstico. Em nosso caso, os cortes longitudinais paraesternais e apicais, permitiram a visibilizaçäo inconfundível de uma estrutura fibrosa em forma de paraquedas, com sua concovidade voltada para a valva aórtica. Cordas próprias conectavam o folheto anômalo as cordoalhas e músculos papilares da valva mitral. Estudo ecoDpplercardiográfico criterioso, näo somente diagnóstica corretamente essa anomalia, com também permite diferenciá-la facilmente de condiçöes como neoplasias, vegetaçöes ou obstruçöes subaórticas clássicas

The accessory mitral valve leaflet is a rare cardiac congenital anomaly usually associated to complex cardiac congenital malformations. It also represents a rare causa of left ventricular outflow tract obstruction. Its diagnosis has often been ignored by conventional diagnostic methods. This fact may represent a causa for relative surgical failure, when operations for cardiac complex anomalies are performed. Echodopplercardiography is the choice and more accurate method for its diagnosis. In our case, parasternal and apical long axis planes, allowed an unmistakable visualization of a parachute shape fibrous structure, with its concave surface turned up towards the aortic valve. Chordae tendinae proper to the anomalous accessory mitral valve tissue were conected to chordae or to papillary muscles of the mitral valve. A careful echodopplercardiographic study will allow us, not only to diagnose this malformation, as well as to differentiate it from other conditions like tumors, vegetations or other types of subaortic obstruction.