Imaging in cardiology R Tukkie, J.A.P. van der Sloot, J.D. Biervliet, A.P. de Jong
Acute haemodynamic conand simultaneous echocardlographic Images of severn systolic anterior motion of the anterior mitral valve leafet following aortlc valve replecement
A 78-year-old female underwent aortic valve replacement because of severe aortic stenosis (peak gradient 105 mmHg, mean gradient 69 mmHg). The left ventricle was xQ1R_ severely hypertrophied with normal systolic contractions. After cessation of cardiopulmonary bypass (CPB) extremely elevated pul'-' Q1 monary pressure developed, which was 25% higher than the low 26 mep systemic pressure (closed arrow in figure 1). Transoesophageal echocardiography (TEE) showed obliteration of the left ventricle, marked systolic anterior motion of the anterior leaflet of the mitral valve with outflow tract obstruction (SAM, arrow in figure 2 left panel) and severe mitral valve regurgita-26 sep tion (figure 2, right panel). After increasing the volume load and administration of 1 mg triglycyl- Figure 1. Trend of the systemic presure measured in the radial artery (ABP);pulmonary lysinevasopressine intravenously artery pressure (PAP) and central venous pr re (CVD) both measured with the Swanthe pulmonary pressure dropped Gans cateter. All pressures in mmHg. Smsystolk, M-mean, D-diastolic. Closed arrow: below the systemic pressure with a SAMpresenton TEE, open arrow: SAMabsenton ThE. Note that the time in thisfigure is subsequent increase in cardiac one hour later than the time of the echo's. S1aS-*
R. Tukkle. J.A.P. van der Sloot. Department of Cardiology. J.D. Blervflet. Department of Anaesthesiology. A.P. de Jong. Department of Cardiothoracic Surgery, Academic Medical Centre, P0 Box 226600, 1100 DD Amsterdam.
Address for correspondence: R. Tukkie. E-mail: [email protected]
Netherlands Heart Journal, Volume I1, Number 5, May 2003
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the
Netherlands. This section is edited by W. Jaarsma and M.J.M. Cramer.
223
lmagng in cardiology
Figure 2 Perioperative multiplane transoesophageal images. Left panel: arrow points at the ckar SAM with makoaptation of the mitral valve and obsction ofthe kft ventricular outflow tract (LVOT). Rightpaneksevere turbuknce in tx left atrium due to the mitral valve
insufficiency and in the LVOT.
Figurm 3. Leftpanel. After the dei4bed interkentionsdisappearance oftheSAMwithan unobstruetedLVOT(arrow). Rightpanelk mild mitral valve insufficiency.
output and systemic pressure (open arrow in figure 1). TEE showed disappearance of the SAM (figure 3, left panel) and only mild mitral valve regurgitation (figure 3, right panel). Further postoperative course was uneventfil. This case demonstrates the anatomic substrate 224
and deleterious haemodynamic consequences of severe SAM and emphasises the usefulness of TEE in the period coming from CPB in severely hypertrophic hearts. U
Netherlands Heart Journal, Volume 11, Number 5, May 2003
Acute haemodynamic conand simultaneous echocardlographic Images of severn systolic anterior motion of the anterior mitral valve leafet following aortlc valve replecement
A 78-year-old female underwent aortic valve replacement because of severe aortic stenosis (peak gradient 105 mmHg, mean gradient 69 mmHg). The left ventricle was xQ1R_ severely hypertrophied with normal systolic contractions. After cessation of cardiopulmonary bypass (CPB) extremely elevated pul'-' Q1 monary pressure developed, which was 25% higher than the low 26 mep systemic pressure (closed arrow in figure 1). Transoesophageal echocardiography (TEE) showed obliteration of the left ventricle, marked systolic anterior motion of the anterior leaflet of the mitral valve with outflow tract obstruction (SAM, arrow in figure 2 left panel) and severe mitral valve regurgita-26 sep tion (figure 2, right panel). After increasing the volume load and administration of 1 mg triglycyl- Figure 1. Trend of the systemic presure measured in the radial artery (ABP);pulmonary lysinevasopressine intravenously artery pressure (PAP) and central venous pr re (CVD) both measured with the Swanthe pulmonary pressure dropped Gans cateter. All pressures in mmHg. Smsystolk, M-mean, D-diastolic. Closed arrow: below the systemic pressure with a SAMpresenton TEE, open arrow: SAMabsenton ThE. Note that the time in thisfigure is subsequent increase in cardiac one hour later than the time of the echo's. S1aS-*
R. Tukkle. J.A.P. van der Sloot. Department of Cardiology. J.D. Blervflet. Department of Anaesthesiology. A.P. de Jong. Department of Cardiothoracic Surgery, Academic Medical Centre, P0 Box 226600, 1100 DD Amsterdam.
Address for correspondence: R. Tukkie. E-mail: [email protected]
Netherlands Heart Journal, Volume I1, Number 5, May 2003
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the
Netherlands. This section is edited by W. Jaarsma and M.J.M. Cramer.
223
lmagng in cardiology
Figure 2 Perioperative multiplane transoesophageal images. Left panel: arrow points at the ckar SAM with makoaptation of the mitral valve and obsction ofthe kft ventricular outflow tract (LVOT). Rightpaneksevere turbuknce in tx left atrium due to the mitral valve
insufficiency and in the LVOT.
Figurm 3. Leftpanel. After the dei4bed interkentionsdisappearance oftheSAMwithan unobstruetedLVOT(arrow). Rightpanelk mild mitral valve insufficiency.
output and systemic pressure (open arrow in figure 1). TEE showed disappearance of the SAM (figure 3, left panel) and only mild mitral valve regurgitation (figure 3, right panel). Further postoperative course was uneventfil. This case demonstrates the anatomic substrate 224
and deleterious haemodynamic consequences of severe SAM and emphasises the usefulness of TEE in the period coming from CPB in severely hypertrophic hearts. U
Netherlands Heart Journal, Volume 11, Number 5, May 2003
