Department of Cardiology, Tokyo Metropolitan Police Hospital.
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
Int Heart J. 2022 May 31;63(3):639-641. doi: 10.1536/ihj.21-673. Epub 2022 May 14.
Surgical valve replacement improves the symptoms and prognosis of patients with valvular heart diseases. Aortic regurgitation elicits volume overload that causes enlargement of the left ventricle (LV), while the LV size often shrinks to near normal after aortic valve replacement (AVR), which is referred to as "reverse remodeling". We experienced a case in which LV outflow tract (LVOT) obstruction became apparent after AVR, resulting in worsening of heart failure. A 65-year-old man who had undergone surgical AVR for aortic valve regurgitation 15 months previously exhibited dyspnea on effort accompanied with severe LVOT obstruction. With double pressure catheters, we directly recorded an augmented pressure gradient in the LVOT and rapid relief of the obstruction by intravenous administration of the anti-arrhythmic drug cibenzoline. Since the considerable LV hypertrophy had been indicated by an electrocardiogram and echocardiography before AVR, we suspected that dilation of the LV chamber due to aortic valve regurgitation could have masked the subclinical LVOT obstruction, which became clinically evident after LV size reduction due to reverse remodeling after AVR.
心脏瓣膜置换术可改善瓣膜性心脏病患者的症状和预后。主动脉瓣反流会引起容量超负荷，导致左心室（LV）增大，而主动脉瓣置换（AVR）后 LV 大小通常会恢复接近正常，这被称为“逆重构”。我们遇到了一例 AVR 后出现 LV 流出道（LVOT）梗阻的病例，导致心力衰竭恶化。一名 65 岁男性，15 个月前因主动脉瓣反流接受了心脏瓣膜置换手术，出现劳力性呼吸困难，并伴有严重的 LVOT 梗阻。我们使用双压力导管直接记录到 LVOT 压力梯度增加，并通过静脉注射抗心律失常药物西苯唑啉迅速缓解梗阻。由于 AVR 前心电图和超声心动图显示 LV 肥厚明显，我们怀疑主动脉瓣反流导致的 LV 腔扩张可能掩盖了亚临床 LVOT 梗阻，这种梗阻在 AVR 后由于逆重构导致 LV 缩小后变得明显。
