Rowin Ethan J, Kimmelstiel Carey
Hypertrophic Cardiomyopathy Institute, Tufts Medical Center, Boston, Massachusetts.
Cardiac Catheterization Laboratory, Tufts Medical Center, Boston, Massachusetts.
Catheter Cardiovasc Interv. 2020 Mar 1;95(4):838-839. doi: 10.1002/ccd.28795.
Evaluation of the severity of aortic stenosis in the presence of dynamic left ventricular outflow (LVOT) obstruction is challenging. Invasive hemodynamic assessment with provocative maneuvers can be useful to differentiate of the relative components of obstruction. In patients with both dynamic LVOT obstruction and aortic stenosis, surgical myectomy and concurrent surgical aortic valve replacement is the optimal treatment strategy; combined alcohol septal ablation and transcatheter aortic valve replacement should only be considered for very high surgical risk patients.
评估存在动态左心室流出道（LVOT）梗阻时主动脉瓣狭窄的严重程度具有挑战性。采用激发动作进行有创血流动力学评估有助于区分梗阻的相关组成部分。对于同时存在动态LVOT梗阻和主动脉瓣狭窄的患者，手术心肌切除术及同期外科主动脉瓣置换术是最佳治疗策略；仅对于手术风险极高的患者才考虑联合酒精室间隔消融术和经导管主动脉瓣置换术。
