Does hypertrophic cardiomyopathy cause mitral regurgitation?
Background: In hypertrophic cardiomyopathy, a spectrum of mitral leaflet abnormalities has been related to the mechanism of mitral systolic anterior motion (SAM), which causes both subaortic obstruction and mitral regurgitation.
What is a significant Lvot gradient?
A significant gradient is generally considered to be an LVOT gradient >50 mmHg (1).
Which gradient is reported when a left ventricular outflow tract obstruction is present?
LVOT obstruction is defined as a peak instantaneous gradient greater than or equal to 30 mm Hg. A gradient greater than or equal to 50 mm Hg is generally recognized as the threshold at which LVOT obstruction becomes hemodynamically significant.
What is Lvot peak gradient?
Peak-to-peak gradient was the difference between the peak LV systolic pressure and the peak central aortic pressure. Peak instantaneous gradient was the maximum gradient present when simultaneous central aortic pressure was subtracted from LV systolic pressure.
What is peak gradient?
First, the peak gradient calculated from the maximum Doppler velocity represents the maximum instantaneous pressure difference across the valve, not the difference between the peak LV and peak aortic pressure measured from the pressure tracings.
What is a normal Lvot?
measurement of LVOT diameter. normal range is between 1.6 and 2.4 cm.
How is Lvot gradient calculated?
LVOT pressure gradient was estimated by utilizing the modified Bernoulli equation: P=4 V2, where P is pressure gradient in mm Hg and V is maximal flow velocity in m/s. For each study, an average of the three highest velocity beats was obtained.
What are the mechanisms of mitral regurgitation in HOCM?
* This mechanism is considered less important , as SAM is almost universal in HOCM but MR occurs in less than 20% patients with HOCM. In HOCM the MR is more often eccentric .This is understandable as the primary mechanism is related to faulty angle of pap ,muscle vs leaflet attachment.
Why does the mitral valve move into the LVOT?
By keeping the heart rate on the low-normal side, we prolong diastole and allow the heart to fill more to alleviate the LVOT obstruction. Here are some transesophageal echo (TEE) clips I acquired of SAM. You can see how the anterior leaflet of the mitral valve (ALMV) moves into the LVOT causing a dynamic obstruction.
Which is an obstruction of the mitral valve?
Systolic Anterior Motion (SAM) Of The Mitral Valve – Left Ventricular Outflow Tract (LVOT) Obstruction. Left ventricular outflow tract (LVOT) obstruction is a potentially catastrophic etiology for hypotension due to several etiologies: idiopathic hypertrophic subaortic stenosis (IHSS), hypertrophic obstructive cardiomyopathy (HOCM),…
What causes left ventricular outflow tract ( LVOT ) obstruction?
Left ventricular outflow tract (LVOT) obstruction is a potentially catastrophic etiology for hypotension due to several etiologies: idiopathic hypertrophic subaortic stenosis (IHSS), hypertrophic obstructive cardiomyopathy (HOCM), systolic anterior motion (SAM) of the mitral valve, and even mid-cavity obstructive hypertrophic cardiomyopathy.