Hypertrophic obstructive cardiomyopathy causing severe right and left ventricular outflow tract obstruction [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2010; 38(3): 206-210

Hypertrophic obstructive cardiomyopathy causing severe right and left ventricular outflow tract obstruction

Gülümser Heper1, Muzaffer Çeliksöz2, Şevket Atasoy2, Füsun İnceer3
1Department of Cardiology, Medicine Faculty of Abant İzzet Baysal University, Bolu
2Department of Cardiovascular Surgery, Etlik İhtisas Hospital, Ankara, Turkey
3Department of Cardiology, Çorum State Hospital, Corum, Turkey

An 18-year-old male patient presented with a 3-year history of exertional dyspnea, dizziness, and angina. Echocardiography showed advanced hypertrophy of the left ventricle (LV), right ventricle (RV) free wall, and interventricular septum. There were apparent muscular bundles especially at the level of the right ventricular outflow tract (RVOT). Maximal pressure gradients across the RVOT and left ventricular outflow tract (RVOT) were 141 mmHg and 66 mmHg, respectively. There was also grade 2 aortic regurgitation. Transesophageal echocardiography and cardiac magnetic resonance imaging confirmed these findings. Despite treatment with propranolol and cibenzoline, the patient remained symptomatic with unchanged pressure gradients. Corrective surgery including an extensive muscular resection of the RVOT, minimal resection of the LVOT, and interposition of a graft patch in the RVOT resulted in complete disappearance of the RVOT gradient and a significant decrease to 28 mmHg in the LVOT gradient. During a year follow-up, aortic valvular insufficiency remained clinically stable and the patient was asymptomatic. This is the first case of hypertrophic obstructive cardiomyopathy with predominant RVOT obstruction treated by myectomy and patch graft interpositioning.

Keywords: Cardiomyopathy, hypertrophic/surgery, hemodynamics, ventricular outflow obstruction/surgery

How to cite this article
Gülümser Heper, Muzaffer Çeliksöz, Şevket Atasoy, Füsun İnceer. Hypertrophic obstructive cardiomyopathy causing severe right and left ventricular outflow tract obstruction. Turk Kardiyol Dern Ars. 2010; 38(3): 206-210

Corresponding Author: Gülümser Heper, Türkiye
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