ABSTRACT
Accessory mitral valve tissue (AMVT) is a rare congenital anomaly that sometimes causes left ventricular outflow tract (LVOT) obstruction. We report the case of a 72-year-old woman with hypertrophic obstructive cardiomyopathy (HOCM) complicated by AMVT. The patient presented at our hospital with palpitations and shortness of breath. Transthoracic echocardiography revealed a diagnosis of HOCM and an abnormal structure inside the LVOT. Transesophageal echocardiography revealed an AMVT. We initially treated the patient with oral medication, but due to side effects, the patient could not take the target dose and her symptoms did not improve. We suggested surgical treatment, but the patient refused. By evaluating the relationship between AMVT and the surrounding tissues using three-dimensional transesophageal echocardiography, we determined that percutaneous septal myocardial ablation (PTSMA) might be successful. The first PTSMA was not effective, but the second procedure showed significant improvement in the pressure gradient and symptoms. The patient with HOCM and concomitant AMVT had a severe LVOT pressure gradient, and PTSMA was performed with excellent results. Since we experienced a rare case and were able to treat it percutaneously, we report our findings in relation to the literature. Learning objective: This case study highlights successful use of percutaneous septal myocardial ablation (PTSMA) in treating a patient with hypertrophic obstructive cardiomyopathy (HOCM) and accessory mitral valve tissue (AMVT). The key objective is to understand PTSMA can be an effective treatment option for HOCM with Type IIa AMVT, characterized by the attachment only to the mitral leaflets, when surgical intervention is not preferred, enhancing management of this rare condition.
ABSTRACT
AIMS: The popularity of B-line-guided congestion assessment by lung ultrasound (LUS) has been increasing. However, the ability of novice residents to detect residual congestion with B-line-guided assessment by LUS after decongestion treatment is poorly understood. In this study, we investigated whether novice residents (no prior echocardiography experience) can acquire the skills for B-line-guided residual congestion assessment and whether the range of variation in assessment is acceptable in actual clinical use. METHODS AND RESULTS: The study included 30 postgraduate first-year novice residents and an expert. The residents underwent training for LUS. At the end of the training session, a set of 15 LUS videos was provided to the residents, and they were asked to estimate the number of B-lines in each video. When the residents' answers greatly differed from the correct answer, we provided feedback to raise awareness of the discrepancies. After the training session, the residents performed residual congestion assessment by LUS after decongestion treatment in patients hospitalized with acute heart failure. The residents identified residual congestion in 57% of the patients. The sensitivity and specificity to identify residual congestion by the residents were 90% and 100%, respectively. The inter-operator agreement between the residents and the expert was substantial (κ = 0.86). The Spearman rank correlation coefficient for the B-lines between the expert and each resident was very high at 0.916 (P < 0.0001). CONCLUSIONS: After a brief lecture, novice residents can achieve proficiency in quantifying B-lines on LUS and can reliably identify residual congestion on LUS.
