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Examples of pathological findings
—Echocardiographic examinations

 —Cardiac function and PA pressure

 —Examples of pathological
findings

Valvular heart disease
Intracardiac masses
Pericardial disease
Cardiomyopathies
Aortic dissection
Congenital heart disease
echo|case

echo|case


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echo|case is an echocardiographic "showcase", intended to present pregnant, visual impressive echocardiographic findings with high didactical value, seen from the point of view and experience of different echocardiographists. This is not a section for case reports, namely, it is not destined for unusual echocardiographic cases or cases of excepcional occurrence.

Left ventricular outflow tract obstruction

Dr. Gustavo Acosta 
Jefe del Laboratorio de Ecocardiografía
Cardiolab
Sanatorio Italiano
Zanotti Cavazzoni esq. España
1429 Asunción, Paraguay
Teléfono +595 (021) 210-357


A 13-year-old male patient was referred by his physician, a general pediatrician, for evaluation to cardiovascular response to exercise. The patient was known having a hypertrophic obstructive cardiomyopathy, compromising the interventricular septum and the apicolateral region of the left ventricle.


Left: Bidimensional mode, para- sternal long axis view. A clear hypertrophy of the interventri- cular septum can be observed.

Right: M-mode of the same projection, a systolic anterior movement (SAM) of the mitral valve can be documented clearly.

Left: left ventricular outflow tract velocities, obtained with conti- nuous wave (CW) Doppler. The obstruction at rest was mild, with values of 30 mmHg.

Right: maximum gradient regis- tered during exercise was 110 mmHg, without significant varia- tions of systemic arterial pressure. The patient had no symptoms during exercise.


In spite of not revealing symptoms and presenting a good exercise condition (9 MET), increase of left ventricular outflow tract obstruction during exercise was significative. This requires optimization of implemented therapy, with subsequent control of gradients during exercise.


References

1. Miranda R, Cotrim C, Cardim N et al. Evaluation of left ventricular outflow tract gradient during treadmill exercise
and in recovery period in orthostatic position, in patients with hypertrophic cardiomyopathy.
Cardiovasc Ultrasound 2008;6:19.

2. Corrado D, Pelliccia A, Bjørnstad HH et al. Cardiovascular pre-participation screening of young competitive
athletes for prevention of sudden death: proposal for a common European protocol.
European Heart Journal 2005;26:516-524.

3. Fernández A, Casabé H, Coronel R et al. Alternativas terapéuticas en la miocardiopatía hipertrófica.
Revista Argentina de Cardiología 2003;71:294-301.



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