Bavishi Aakash, Nazif Kutaiba, Bryde Robyn, Martinez Matthew W
University of Illinois-Chicago, Chicago, Illinois, USA.
Atlantic Health Medical Center, Morristown, New Jersey, USA.
JACC Case Rep. 2025 Apr 2;30(7):103385. doi: 10.1016/j.jaccas.2025.103385.
Thorough and accurate evaluation of left ventricular outflow tract (LVOT) obstruction is critical in the assessment and management of patients with hypertrophic cardiomyopathy (HCM). Although Doppler echocardiography has become the initial modality to assess LVOT obstruction, it may not identify all patients with labile obstruction. In patients with a high clinical suspicion of LVOT obstruction, further provocative testing is needed. In HCM patients with poor transthoracic echocardiogram windows or who are unable to exercise, isoproterenol-guided transesophageal echocardiogram (TEE) remains a viable option to assess for systolic anterior motion (SAM) and LVOT obstruction. We report 4 individuals in whom there was no obvious SAM or LVOT obstruction at rest but who had severe LVOT obstruction unmasked by isoproterenol-guided TEE.
对肥厚型心肌病（HCM）患者进行评估和管理时，全面准确地评估左心室流出道（LVOT）梗阻至关重要。尽管多普勒超声心动图已成为评估LVOT梗阻的初始方法，但它可能无法识别所有存在间歇性梗阻的患者。对于临床高度怀疑LVOT梗阻的患者，需要进一步进行激发试验。对于经胸超声心动图检查窗不佳或无法进行运动的HCM患者，异丙肾上腺素引导下的经食管超声心动图（TEE）仍是评估收缩期前向运动（SAM）和LVOT梗阻的可行选择。我们报告了4例患者，他们在静息状态下没有明显的SAM或LVOT梗阻，但在异丙肾上腺素引导下的TEE检查中发现了严重的LVOT梗阻。
