Echocardiographic insights into the mechanisms of relief of left ventricular outflow tract obstruction after nonsurgical septal reduction therapy in patients with hypertrophic obstructive cardiomyopathy
Ramiro Flores-Ramirez, MDa,
Nasser M. Lakkis, MD, FACCa,
Katherine J. Middleton, RCTa,
Donna Killip, RNa,
William H. Spencer, III, MD, FACCa and
Sherif F. Nagueh, MD, FACCa
a Department of Medicine, Cardiology Section, Baylor College of Medicine, Houston, Texas, USA
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Figure 1 Parasternal long-axis view (LAX) of left ventricular outflow tract at baseline and six months after nonsurgical septal reduction therapy (NSRT). Note the thinning of the septal base and the widening of the outflow tract.
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Figure 2 Relation of the change in left ventricular outflow tract gradient to that in left ventricular outflow tract (LVOT) diameter (left) and end-diastolic mitral septal distance (right) as observed in the initial population. AML = anterior mitral leaflet.
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Figure 3 Relation of the change in left ventricular outflow tract (LVOT) gradient to that in the angle between left ventricular systolic flow and mitral leaflets as observed in the initial population. AML = anterior mitral leaflet.
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Figure 4 Relation of the change in left ventricular outflow tract gradient (LVOT) to that in peak acceleration rate (left) and acceleration time/ejection time (AT/ET) (right) in the initial population.
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Figure 5 Pulse Doppler recordings of left ventricular systolic flow at a point 2.5 cm apical to the mitral valve. The left panel shows the baseline data with immediate changes after ethanol injection in the middle panel and the six-week results on the right. Notice the increase in acceleration time relative to ejection time. NSRT = nonsurgical septal reduction therapy.
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Figure 6 Relation of the change in left ventricular outflow tract (LVOT) gradient acutely in the catheterization laboratory to that in peak acceleration rate (left) and acceleration time/ejection time (AC/ET) (right) in the test population.
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Figure 7 Relation of the change in left ventricular outflow tract gradient to that in left ventricular outflow tract (LVOT) diameter (left) and end-diastolic mitral septal distance (right) six weeks after NSRT as observed in the test population. AML = anterior mitral leaflet.
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