Putra Bayushi Eka, Sukmawan Renan, Ariani Rina, Soesanto Amiliana M, Kuncoro Ario Soeryo
Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
J Cardiovasc Echogr. 2020 Apr-Jun;30(2):104-109. doi: 10.4103/jcecho.jcecho_58_19. Epub 2020 Aug 17.
Concurrent lesions of dynamic left ventricular outflow tract obstruction (DLVOTO) with aortic stenosis pose a challenge in the measurement of the pressure gradient and severity of each lesion. Determining the true culprit lesion is difficult and challenging. The establishment of true culprit lesion is crucial in deciding the future course of action. We present two cases of concurrent DLVOTO and aortic stenosis. Although the composition of lesions is similar, the severity of each lesion was different and described a variety of technical problems. Finding the culprit through the shape of the stenotic jet from the continuous wave Doppler as well as other different technical approaches is the critical point of this case report. The first patient showed nonsignificant DLVOTO with severe aortic stenosis in which transthoracic echocardiography (TTE) alone was sufficient to find the culprit. Meanwhile, the second patient concluded to have significant DLVOTO with moderate aortic stenosis based on TTE and transesophageal echocardiography examination data. Jet morphology from Doppler examination is a crucial finding to differentiate DLVOTO with aortic stenosis, along with other parameters that might help find the dominant lesion. Multiple modalities with several tailor-made technical considerations might be needed to establish a culprit lesion.
动态左心室流出道梗阻(DLVOTO)合并主动脉瓣狭窄的病变在测量每个病变的压力阶差和严重程度方面构成挑战。确定真正的责任病变既困难又具有挑战性。确定真正的责任病变对于决定未来的治疗方案至关重要。我们展示两例DLVOTO合并主动脉瓣狭窄的病例。尽管病变组成相似,但每个病变的严重程度不同,并描述了各种技术问题。通过连续波多普勒狭窄射流的形状以及其他不同技术方法找出责任病变是本病例报告的关键点。首例患者表现为轻度DLVOTO合并严重主动脉瓣狭窄,仅经胸超声心动图(TTE)就足以找出责任病变。同时,根据TTE和经食管超声心动图检查数据,第二例患者诊断为重度DLVOTO合并中度主动脉瓣狭窄。多普勒检查的射流形态是区分DLVOTO与主动脉瓣狭窄的关键发现,以及其他可能有助于找出主要病变的参数。可能需要多种具有多种定制技术考量的方法来确定责任病变。
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