TITLE

Hemodynamic Characteristics of Obstructive Cardiomyopathy

AUTHOR(S)
Befeler, Benjamin; Wells, David E.; Machado, Humberto; Aranda, Juan M.
PUB. DATE
January 1979
SOURCE
Angiology;Jan1979, Vol. 30 Issue 1, p27
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Dynamic right ventricular outflow obstruction in hypertrophic obstructive cardiomyopathy is said to occur in 10 to 20% of patients. Isolated obstruction of the right ventricular outflow is rare in this entity. Since it is known that this type of cardiomyopathy involves the entire myocardium, dynamic gradients were sought in the right ventricle systematically in 12 patients evaluated by a two-catheter technique to establish whether this is a true incidence. This study demonstrates that every patient with clinical, echocardiographic, hemodynamic, and angiographic evidence of left ventricular outflow obstruction either had at rest a dynamic gradient in the right ventricle outflow, or developed one with provocative interventions. These interventions were analysis of postextrasystolic beats, Valsalva maneuvers, amyl nitrite inhalation, and isoproterenol infusion. Five patients had resting gradients on the left side. In 4 the pulse pressure narrowed after an extrasystole; 7 increased their gradients with the Valsalva maneuver, and 1 other patient increased the gradient during the release phase. Amyl nitrite increased the gradient in 10 of 12, and isoproterenol increased the gradient in 6 of 9 patients tested. One patient did not demonstrate a gradient during any of the phases of the study on the left side, but had typical echocardiographic and angiographic appearance. On the right side II patients had small systolic gradients at rest. They increased in 3 after extrasystole, and in 5 they increased with the Valsalva maneuver. The gradient increased in 8 of 11 with amyl nitrite, and isoproterenol generated a large gradient in 10 patients. This study demonstrates that dynamic right ventricular obstruction is more common than generally appreciated: it was noted in every patient studied. The possible mechanisms by which the gradient is brought out by the different maneuvers are discussed, and the importance of a two-catheter technique is noted.
ACCESSION #
16902449

 

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