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Abstract
Background
Mid-ventricular obstruction(MVO) of the left ventricle has been reported to be associated with mid-ventricular hypertrophy, papillary muscle hypertrophy, severe apical hypertrophy, elderly hypertension, and dobutamine stress echocardiography(DSE). The aim of this sutdy is to determine the clincial and echocardiographic features of MVO.
Method
MVO was defined as systolic hourglass narrowing of the left mid-ventricle in the apical long axis view with turbulent flow exceeding 1m/s. Fifteen patients were subjected to this retrospective analysis. Baseline patients characteristics were mean age 56(range, 26–74) years, male gender 10(66%). Associated diseases were hypertrophic cardiomyopathy 9, aortic stenosis 1, hypertension without left ventricular hypertrophy(LVH) 1, old myocardial infarction with apical aneurysm 2, stable angina 1, and idiopathic 1. DSE was performed in 7 of 15 subjected patients to evaluate the chest pain.
Results
All patients had mild symptoms; chest tightness, palpitation, and weakness, without syncope nor hypotension. MVO was observed in 10 at rest, and 5 after provocation; DSE 3, VPB 1, atropine 1. Observed peak velocity in the mid-ventricle ranged from 1.2 to 5.5m/s (mean; 2.8 ± 1.6m/s). Left ventricular outflow tract obstruction defined as the peak flow velocity exceeded 1.5m/s, was also present in 8. in 7 underwent to DSE, systolic blood pressure was changed from 144 ± 15mmHg at rest to 175 ± 28mmHg at peak, heart rate from 73 ± 12/min to 108 ± 23/min, left ventricular end diastolic dimension from 42 ± 5mm to 37 ± 4mm. ejection fraction from 66 ± 10% to 80 ± 6%, and peak flow velocity at the mid-ventricle from 1.0 ± 0.6 m/s to 3.3 ± 1.7m/s.
References
1). Falicov RE, Resnekov L, Bharati S, Lev M. Mid-ventricular obstruction: A variant of obstructive cardiomyopathy. Am J Cardiol. 37:432–437. 1976.
2). Wigle ED, Sasson Z, Henderson MA, et al. Hypertrophic cardiomyopathy: The importance of the site and the extent of hypertrophy. A Review. Prof Cardovasc Dis. 28:1–83. 1985.
3). Zoghbi WA, Haichin RN, Quiones MA. Mid-cavity obstruction in apicial hypertrophy: Doppler evidence of diastolic intraventricular gradient with higher apical pressure. Am Heart J. 116:1469–1474. 1988.
4). Bruyne B, Marchandise B, Kremer R. Apical hypertrophic cardiomyopathy of the Japanese type in Western countries. Am J Med. 82:1087–1088. 1987.
5). Louie EK, Maron BJ. Apical hypertrophic cardiomyopathy clinical and two-demensional echocardiographic assessment. Ann Intern Med. 106:663–670. 1987.
6). Maron BJ, Bonow RO, Seshagiri TNR, Roberts WC, Epstein SE. Hypertrophic cardiomyopathy with ventricular sepal hypertrophy localized at the apical region of the left ventricle (apical hypertrophic cardiomyopathy). Am J cardiol. 49:1838–1848. 1982.
7). Sutsch G, Jenni R, Krayenbuhl HP. Left ventricular flow from apex to base during systole and isovolumic relaxation in a patient with hypertrophic cardiomyopathy and midventricular obstruction. European Heart Journal. 12:1132–1139. 1991.
8). Barbier P, Bartorelli AL. Doppler evidence of abnormal intracavitary systolic and diastolic flow in hypertrophic cardiomyopathy with midventricular obstruction. Am Heart J. 126(2):483–487. 1993.
9). Gordon EP, Henderson MA, Rakowski H, Wingle ED. Midventricular obstruction with apical infarction and aneurysm formation <Abstract>. Circulation. 70(supp2):145. 1994.
10). Harrison MR, Grigsby CG, Souther SK, Smith Demaria. Midventricular obstruction associated with chronic systemic hypertension and severe left ventricular hypertrophy. Am J Cardiol. 68(8):761–765. 1991.
11). Blazer D, Kotler MN, Parry WR, Qertheimer J, Nakhavan FK. Noninvasive evaluation of mid-left ventricular obstrucition by two-dimensional and Doppler echocardiography and color flow Doppler echocardiography. Am Heart J. 114:1162. 1987.
12). Pellikka PA, Oh JK, Bailey KR, Nichols BA, Monahan KH, and Tajik AJ. Dynamic Intraventricular Obstruction During Dobutamine Stress Echocardiography. Circulation. 86:1429–1432. 1992.
13). Hoffmann R, Lethen H, Kleinhans E, Weiss M, Flachskampf FA, Hanrath P. Comparative Evaluation of Bicycle and Dobutamine Stress Echocardiography with Perfusion Scintigraphy and bicycle Electrocardiogram for Identification of Coronary Artery disease. Am J Cardiol. 72:555–559. 1993.
Table 1.
Age and sex distribution of midventricular obstruction
| Age(years) | Male | Female | Total |
|---|---|---|---|
| 20–29 | 1 | 1 | |
| 30–39 | 2 | 2 | |
| 40–49 | 3 | 3 | |
| 50–59 | 2 | 2 | |
| 60–69 | 1 | 3 | 4 |
| 70– | 2 | 1 | 3 |
| Total | 10 | 5 | 15 |
Table 2.
Associated disease or provacative factor of midventricular obstruction
Table 3.
Association with LVOT Obstruction
| Rest(No = 6) | Provocation (No = 2) | ||
|---|---|---|---|
| HCM | 6 | Idiopaihic(by Dob) | 1 |
| septal | 4 | Concentric HCM(by Dob) | 1 |
| concentric | 2 |
Table 4.
Dobutamine stress echocardiography and MVO
| Provocation of MVO | (No = 4) |
| Concentric HCM | 1 |
| MI | 1 |
| Stable angina | 1 |
| Idiopathic | 1 |
| Aggrevation of MVO | (No = 3) |
| Concentric HCM | 1 |
| Apical HCM | 1 |
| Ml | 1 |
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