Ventricular Outflow Obstruction

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A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and Right Ventricular Outflow Tract Obstruction

Melik Demir et al. Murat Gök Muhammet Gürdoğan Osman Kula … Fethi Emre Ustabaşıoğlu Kenan Yalta

Abstract

Coronary-cameral fistulas, though mostly regarded as congenital entities, have also been encountered as complications of major traumas and percutaneous coronary interventions (PCIs). On the other hand, interventricular septal (IVS) hematoma might potentially arise mostly during retrograde chronic total occlusion (CTO) interventions and has a benign course in this context. Herein, we describe a challenging PCI complication (and its management strategy) presenting with IVS hematoma, right ventricular fistula, and right ventricular outflow tract (RVOT) obstruction due to a misimplanted coronary stent in the septal perforating artery (SPA).

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Review Article

Exercise Stress Echocardiography in Hypertrophic Cardiomyopathy: How, When and Why?

Joselina Luzia Menezes Oliveira et al. Katia Oliveira Nunes Leal Larissa Rebeca da Silva Tavares Irlaneide da Silva Tavares … Luiz Flávio Galvāo Gonçalves Daniel Pio de Oliveira Ursula Maria Moreira Costa Burgos Eduardo José Ferreira José Oliveira Belem Marilia Marques Aquino Antonio Carlos Sobral Sousa

Abstract

Historically, the role of exercise stress echocardiography in the management of hypertrophic cardiomyopathy has been neglected in clinical practice according to the analysis of the 2002 Guidelines of the American College of Cardiology/ American Heart Association, which recommended caution use of this methodology in patients with hypertrophic cardiomyopathy due to the risk of both cardiac arrhythmia and hemodynamic collapse on exertion. Exercise stress testing in patients with hypertrophic cardiomyopathy is currently part of the routine assessment of symptomatic patients with or without a resting left ventricular outflow tract gradient < 50 mmHg. For this group, it is a safe and reliable method for measuring the left ventricular outflow tract gradient during exertion and a solid differentiator of patients with nonobstructive hypertrophic cardiomyopathy (absent gradient, both at rest and on exertion) from those with labile gradients (absent gradient at rest and present on exertion). Therefore, in the assessment of hypertrophic cardiomyopathy, exercise stress is equally useful for quantifying the degree of mitral regurgitation and left ventricular segmental contractility changes as well as assessing left ventricular diastolic function on exertion and is able to predict the future development of heart failure symptoms. The method is also important for determining different treatment strategies for each patient, from surgical myomectomy or alcohol septal ablation for those with a labile gradient, limiting symptoms, and who refractory to drug treatment to heart transplantation for those without a gradient.

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A Stent Misplaced in the Septal Perforating Artery: Right Ventricular Fistula, Interventricular Septal Hematoma, and Right Ventricular Outflow Tract Obstruction

Abstract

Exercise Stress Echocardiography in Hypertrophic Cardiomyopathy: How, When and Why?

Abstract

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Electronic Document Format (ISO)