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Updated: May 12, 2026
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Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Symptomatic exercise-induced left ventricular outflow tract obstruction without left ventricular hypertrophy.
Eyad K Alhaj1, Bette Kim, Deborah Cantales
1Division of Cardiology, Department of Medicine, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Summary
Dynamic left ventricular outflow tract obstruction (DLVOTO) can occur without LV hypertrophy, causing significant gradients and symptoms. Elongated mitral valve leaflets and anterior papillary muscles are key factors in this exercise-induced condition.
Area of Science:
- Cardiology
- Echocardiography
- Cardiac Physiology
Background:
- Left ventricular outflow tract obstruction (LVOTO) is typically associated with hypertrophic cardiomyopathy.
- Postexercise dynamic LVOTO (DLVOTO) in patients without LV hypertrophy is uncommon, with poorly understood pathophysiology.
Purpose of the Study:
- To identify echocardiographic abnormalities contributing to dynamic systolic anterior motion, mitral-septal contact, and LVOTO in patients without LV hypertrophy.
Main Methods:
- Compared patients with DLVOTO and normal wall thickness to age- and gender-matched controls.
- Also compared patients with DLVOTO and mild segmental hypertrophy, and those with dobutamine-induced DLVOTO.
Main Results:
- Six patients with normal LV wall thickness developed exercise-induced DLVOTO with mean gradients of 107 mm Hg.
- All patients exhibited structural mitral valve abnormalities, including elongated leaflets and increased protrusion.
- Anterior papillary muscle positioning was observed in patients with DLVOTO.
Conclusions:
- Exercise-induced DLVOTO can occur without LV hypertrophy, presenting with high gradients and symptoms.
- Elongated mitral valve leaflets and anteriorly positioned papillary muscles are implicated in the obstruction mechanism.
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