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Updated: Jan 15, 2026

Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China

Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China

Published on: February 11, 2022

左室流出路閉塞を誘発する僧帽輪石灰化に対するアルコール中隔アブレーション

Joseph Hajj¹, Trent L Wei¹, Serge C Harb¹

¹Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.

JACC. Case reports

|January 14, 2026

要旨

Background:

Mitral annular calcification (MAC) can rarely extend into the left ventricular outflow tract (LVOT), causing dynamic obstruction that mimics hypertrophic cardiomyopathy. Management is especially challenging in patients with prior valve surgery.

Case Summary:

A 73-year-old woman with prior surgical aortic and mitral valve replacements presented with exertional dyspnea and fatigue. Echocardiography showed dynamic LVOT obstruction. Cardiac computed tomography revealed dense MAC and subvalvular calcification encroaching on the LVOT. Due to high surgical risk, the heart team pursued alcohol septal ablation. The LVOT gradient decreased from 107 to 40 mm Hg on echocardiography and from 42 to 23 mm Hg invasively. Symptoms improved immediately and were sustained at 30-day follow-up.

Discussion:

This case illustrates a rare mechanism of LVOT obstruction and highlights alcohol septal ablation as a potential solution in anatomically complex, inoperable patients.

Take-Home Messages:

MAC-related LVOT obstruction is an uncommon but important diagnostic consideration. Alcohol septal ablation may be a viable option for select high-risk surgical patients.

キーワード:

画像診断左心室僧帽弁

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