Harano Yoshihiro, Kawase Yoshiaki, Matsuo Hitoshi
Department of Cardiovascular Medicine, Gifu Heart Centre, 4-14-4 Yabutaminami, Gifu 500-8384, Japan.
Eur Heart J Case Rep. 2022 Jul 25;6(8):ytac311. doi: 10.1093/ehjcr/ytac311. eCollection 2022 Aug.
Beta-blockers and Class 1A antiarrhythmics decrease the subaortic pressure gradient in hypertrophic obstructive cardiomyopathy. However, real-time monitoring of the pressure gradient transition during intravenous therapy, based on cardiac catheterization, has never been reported.
A 52-year-old man, with an history of hypertension, was transferred to our hospital, complaining of angina. A 12-lead electrocardiogram showed diffuse ST-segment depression, and transthoracic echocardiography revealed a thickened left ventricular outflow tract (LVOT) septum, resulting in LVOT obstruction which had never been diagnosed. Besides, severe mitral regurgitation (MR) due to systolic anterior motion was detected. Emergent cardiac catheterization revealed normal coronary arteries and severe MR. Simultaneous pressure measurements were taken at the ascending aorta (using a coronary catheter) and left ventricle (using a pressure wire). The subaortic systolic pressure gradient was 147 mmHg: 251 mmHg in the left ventricle and 104 mmHg in the aorta. Intravenous cibenzoline, following propranolol, was administered to ameliorate the pressure gradient, following which his chest pain disappeared immediately; the pressure gradient decreased to 13 mmHg. Further, severe MR was diminished. Oral bisoprolol and cibenzoline administration effectively stabilized his condition after catheterization.
Monitoring the simultaneous pressure between the left ventricle and aorta with a pressure wire revealed drastic improvement in the subaortic systolic pressure gradient. Owing to the soft, fine structure, the pressure wire allowed recording of the subaortic pressure gradient stably with less frequent premature ventricular contractions. Furthermore, this method could decrease the burden of catheter-related complications by eliminating the need for multiple atrial punctures.
β受体阻滞剂和ⅠA类抗心律失常药物可降低肥厚性梗阻性心肌病的主动脉下压力梯度。然而，基于心导管检查的静脉治疗期间压力梯度变化的实时监测尚未见报道。
一名52岁男性，有高血压病史，因胸痛转至我院。12导联心电图显示弥漫性ST段压低，经胸超声心动图显示左心室流出道（LVOT）间隔增厚，导致此前未被诊断出的LVOT梗阻。此外，检测到因收缩期前向运动导致的严重二尖瓣反流（MR）。急诊心导管检查显示冠状动脉正常但存在严重MR。同时在升主动脉（使用冠状动脉导管）和左心室（使用压力导丝）进行压力测量。主动脉下收缩期压力梯度为147 mmHg：左心室为251 mmHg，主动脉为104 mmHg。在给予普萘洛尔后静脉注射西苯唑啉以改善压力梯度，随后其胸痛立即消失；压力梯度降至13 mmHg。此外，严重MR减轻。心导管检查后口服比索洛尔和西苯唑啉有效稳定了他的病情。
使用压力导丝监测左心室和主动脉之间的同步压力显示主动脉下收缩期压力梯度有显著改善。由于压力导丝柔软、结构精细，能够以较少的室性早搏稳定记录主动脉下压力梯度。此外，这种方法通过无需多次心房穿刺可减轻与导管相关并发症的负担。
