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Dynamic Left Ventricular Outflow Tract Obstruction Post-Transcatheter Aortic Valve Replacement.
Hellmuth S vH Weich1, Thadathilankal-Jess John1, Lloyd Joubert1
1Division of Cardiology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa.
JACC. Case Reports
|July 28, 2021
Summary
This study presents the first successful management of left ventricular outflow tract obstruction after transcatheter aortic valve replacement using right ventricular apical pacing. The findings offer insights into resolving this serious complication.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Left ventricular outflow tract (LVOT) obstruction can be a rare but serious complication after TAVR.
- Management strategies for late-onset LVOT obstruction post-TAVR are not well-established.
Observation:
- A case of late-onset LVOT obstruction was observed following TAVR.
- The obstruction significantly impacted cardiac function and patient hemodynamics.
- Conventional medical management failed to resolve the obstruction.
Findings:
- Successful resolution of LVOT obstruction was achieved using right ventricular apical pacing.
- The pacing strategy appears to alter the dynamic obstruction.
- Potential mechanisms for obstruction resolution are discussed, including altered myocardial strain and improved diastolic function.
Implications:
- Right ventricular apical pacing offers a novel, minimally invasive therapeutic option for managing late LVOT obstruction post-TAVR.
- This approach may prevent the need for re-intervention in select patients.
- Further research is warranted to elucidate the precise mechanisms and patient selection criteria.
Keywords:
HCM, hypertrophic cardiomyopathyHOCM, hypertrophic obstructive cardiomyopathyLVH, left ventricular hypertrophyLVOT, left ventricular outflow tractLVOTO, left ventricular outflow tract obstructionSAM, systolic anterior motion of the mitral valveSAVR, surgical aortic valve replacementTAVR, transcatheter aortic valve replacementaortic valvecardiomyopathypacemakervalve replacementMore Related Videos
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