Ventricular Septal Hypertrophy Research Articles

Case Presentation: A 50-year-old man experienced unintended weight loss and required more intensive antihypertensive therapy over the preceding several months prior to presentation, as well as new-onset headaches beginning a few days before presentation. On the day of presentation, he suddenly collapsed while playing a Japanese gambling machine. However, no bystander-initiated cardiopulmonary resuscitation was initiated. Emergency medical services personnel delivered two shocks using a defibrillator. Return of spontaneous circulation was briefly achieved but not sustained. He was transported to an emergency department by ambulance. His refractory ventricular fibrillation prompted the initiation of venoarterial extracorporeal membrane oxygenation as a life-saving measure. Differential Diagnosis: Coronary angiography performed immediately after venoarterial extracorporeal membrane oxygenation revealed no significant stenosis. Computed tomography uncovered a large right adrenal mass with a maximum diameter of approximately 95 mm (Image). Abdominal T2-weighted magnetic resonance imaging (MRI) revealed a hyperintense lesion within the right adrenal gland． 123 I-meta-iodobenzylguanidine scintigraphy demonstrated intense radiotracer uptake corresponding to the adrenal mass. Furthermore, transthoracic echocardiography identified ventricular septal hypertrophy measuring approximately 19 mm. Cardiac MRI illustrated that the hypertrophy of ventricular septum was relatively uniform. These findings were highly suggestive of pheochromocytoma-induced cardiomyopathy. Treatment and Management: Venoarterial extracorporeal membrane oxygenation was successfully weaned on hospital day 3. On hospital day 23, he underwent open right adrenalectomy, and histopathological examination confirmed pheochromocytoma. Outcome and Follow-up: To prevent recurrent life-threatening arrhythmia, we implanted a cardioverter–defibrillator on hospital day 35. The postoperative course was uneventful, and he was discharged on hospital day 43. Discussion/Teaching Points: Because cardiomyopathy might not quickly resolve after surgery, we implanted a cardioverter–defibrillator in this patient to prevent recurrent cardiac arrest. Although pheochromocytoma-induced cardiomyopathy is relatively rare, most cases are incidentally discovered using clinical images. As the present case illustrates, early detection and rapid therapy could enable the patient to be discharged without any complications.

Infective Endocarditis Complicated by Rupture of Cerebral Mycotic Aneurysm in a Child with Obstructive Hypertrophic Cardiomyopathy: A Case Report with Review of the Literature

Duchenne muscular dystrophy is characterised by fibrofatty replacement of muscle, resulting in dilated cardiomyopathy. Hypertrophic cardiomyopathy affects 1:200-1:500 people and is characterised by asymmetric ventricular septal hypertrophy. To date, there have been two separately reported cases describing the combined pathology of these disorders. Herein, we expand upon these reports with a case series describing longitudinal findings in three patients with Duchenne muscular dystrophy who developed hypertrophic cardiomyopathy.

Left bundle branch area pacing (LBBAP) aims to provide physiological ventricular activation during pacing. Left ventricular septal hypertrophy (LVSH) might be challenging for LBBAP due to the thickness of the interventricular septum and potential presence of septal scar. This study assesses the feasibility, safety, and outcome of LBBAP in patients with LVSH using primarily stylet-driven leads (SDL). Adult patients with LVSH who underwent LBBAP between March 2019 and November 2022 were enrolled. Baseline patient characteristics, procedural data and postprocedural results were collected. The feasibility of LBBAP in LVSH patients was compared to a cohort of LBBAP patients with normal septal wall thickness (NST). SeventeenLVSH and 133 NST patients underwent LBBAP with successful implantation achieved in 15 LVSH patients (88%). Mean implant depth was 17.2 ± 1.9 mm, with 53% proven left bundle branch (LBB) capture. Paced QRS duration (146 ± 14 ms) and V6 R-wave peak time (V6 RWPT; 79 ± 20 ms) were comparable between patients with and without septal hypertrophy, although patients with NST had higher rates of proven LBB capture (71% vs. 53%). In LVSH pacing thresholds (0.6 ± 0.3 V at 0.4 ms) and R-wave amplitude (13.9 ± 5.6 mV) were favorable and remained stable at follow-up. At 12 months, 87% of patients had stable or improved left ventricular ejection fraction. The results of the study indicate that LBBAP in patients with LVSH is safe and feasible and no lead-related complications were observed despite a mean implant depth exceeding 15 mm. LBBAP using SDL results in favorable pacing and electrocardiographic characteristics in LVSH patients, comparable to patients with NST.

An asymptomatic three-year-old male European Domestic Shorthair cat was referred for an irregular heart auscultation. Apart from localized concentric left ventricular septal hypertrophy, echocardiography was normal. However, ventricular ectopy was observed on electrocardiography (ECG) during echocardiography. The cat died suddenly 55 minutes after the start of the subsequent Holter ECG. Analysis showed sinus rhythm interrupted by 192 single ventricular premature complexes, a ventricular couplet, two incidents of ventricular bigeminy and two runs of ventricular tachycardia (VT). The last run of VT deteriorated into ventricular fibrillation (VF) and ultimately cardiac arrest. Structural heart disease including mild feline hypertrophic cardiomyopathy or myocarditis, primary arrhythmia (channelopathy) or extra-cardiac disease were maintained as differential diagnosis. Unfortunately, a necropsy was declined leaving no definitive diagnosis available. In this case report, it is shown that VF due to ventricular ectopy is a possible cause of SCD even in asymptomatic cats with only mild echocardiographic signs of structural heart disease.

Background: Gestational diabetes mellitus (GDM) can cause diastolic dysfunction and asymmetric ventricular septal hypertrophy in infants of gestational diabetic mothers (IGDMs). Ventricular thickness can affect QT interval and other QT parameters. Objectives: This study aimed to evaluate and compare the duration of QT, corrected QT (QTc), QT dispersion (QTD), and echocardiographic indices in two groups of neonates of mothers with and without GDM. Methods: In this case-control study, 76 term neonates were enrolled. The case group (n = 38) included IGDM, and the control group (n = 38) included neonates born to healthy mothers. The QT, QTD, and QTc were calculated based on electrocardiographic results. Ejection fraction (EF), interventricular septal thickness at the end of diastole (IVSTD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular posterior wall thickness (LVPWT) were evaluated by performing echocardiography, and the two groups were compared regarding them. Data were analyzed using SPSS version 21. Results: In this study, neonates' mean age and weight were 4.18 ± 1.3 days and 3418.16 ± 549.24 grams, respectively. As for the gender of neonates, 68.4% in the case group and 47.4% in the control group were female. The two groups had no significant difference regarding age, weight, and sex (P > 0.05). Minimum QTc (QTc min) was significantly higher in the case group (P = 0.046). Considerably lower EF and higher IVSTD were found in the case group (P = 0.011 and P = 0.05 respectively). In univariate analysis, echocardiographic parameters were not the predictors of QTD (P > 0.05); in multivariate analysis, however, QTD was significantly correlated with LVEDD (P = 0.001) and LVESD (P = 0.015). Conclusions: A higher proportion of septal hypertrophy was detected in IGDMs compared to infants of the healthy mothers without any correlation with ECG indices. This involvement was accompanied by relatively decreased EF verified by echocardiography. Most ECG findings, including QTD values, had no linear relationship with echocardiographic parameters except for LVEDD and LVESD.

BackgroundCoronary artery-left ventricular multiple micro-fistulas (CA-LVMMFs) is a rare congenital vascular anomaly that may present with no obvious clinical symptoms or a typical angina attack. CA-LVMMFs is usually found unexpectedly during coronary angiography (CAG).Case presentationWe report a case of a 65-year-old man admitted to the hospital with acute coronary syndrome. CA-LVMMFs was found during coronary angiography. Echocardiography showed apical hypertrophy and blood flow signals were seen in the apical myocardium, connected with the left ventricle. We searched the MEDLINE database and found 39 relevant reports. We made statistics on the clinical characteristics of these patients and found half involved hypertrophy or perfusion defects in the ventricular septum or apex.ConclusionAs a rare congenital anomaly, the effect of CA-LVMMFs on patients is unclear. By reporting a case and summarizing literature reports, we found that CA-LVMMFs may be associated with myocardial hypertrophy, especially ventricular septal and apical hypertrophy.

Rationale: Cardiovascular and chest involvement in a pandemic COVID-19 virus infection may be vital.Bifascicular heart block is affecting the conduction delay or block below the AVN in two of the three fascicles. There is a correlation between mortality with sudden cardiac death (SCD) and bifascicular block. SISIISIII pattern is meaning that the S-waves of amplitude is more than 1.5 mm in I, II, and III. It is a variable prognostic electrocardiographic finding. Patient concerns: A 67-year-old, retired officer, smoker, married, Egyptian male patient was admitted to the intensive care unit with right bundle branch block, left anterior fascicular block, and mild COVID-19 pneumonia with slight pleural effusion. Diagnosis: Bifascicular block with ECG SISIISIII pattern in mild COVID-19 pneumonia with slight pleural effusion. Interventions: Electrocardiography, oxygenation, non-contrast chest CT, and echocardiography. Outcomes: Good response and better outcomes despite the presence of several remarkable risk factors were the results. Lessons: Associated hypoxia in the current COVID-19 pneumonia may play an essential role in the present new bifascicular heart block. SISIISIII pattern represents a variable prognostic ECG finding such as RVH, pulmonary embolism, and congenital heart disease. The presence of left ventricular septal hypertrophy is considered another risk. The presence of the elderly male sex, heavy smoker, COVID-19 pneumonia, pleural effusion, bifascicular heart block, SISIISIII pattern, and interventricular septal hypertrophy are prognostic factors for the severity of the disease.

Hypertrophic cardiomyopathy (HCM) characterized by asymmetric ventricular septal hypertrophy, is the commonest cause of sudden cardiac death (SCD) in the young. The underlying etiology of HCM in the childhood and adolescent patients is diverse. Moreover, the prognosis of pediatric HCM depends on the age of presentation and etiology. Despite the complexity of children with obstructive HCM, surgical treatment results in a favorable outcome for carefully selected patients in experienced tertiary referral center in contemporary era. Implantable cardioverter-defibrillator (ICD) remains the most effective and reliable treatment to prevent SCD. New pediatric SCD risk prediction model, which has good discrimination and calibration and can distinguish patients who are most benefit from an ICD implantation, is expected to be further refined in the future.

Maternal diabetes mellitus (DM) is a chronic disease that carries significant risks for the fetus and newborn. Hyperglycemia during pregnancy contributes to the development of structural heart defects, myocardial hypertrophy, and impaired cardiac function in newborns. The objective of the study was to evaluate the echocardiographic parameters of the cardiac function in children born to mothers with type 1 diabetes mellitus (DM1).A prospective study of 163 newborns was conducted on the basis of the Republican Scientific and Practical Center “Mother and Child”. The children were divided into 2 groups. The main group consisted of 107 children born to mothers with DM1 (Gr1), the control group – 56 healthy infants born to women with normoglycemia during pregnancy (Gr2).It was found that a newborn in Gr1 has a larger thickness of the interventricular septum (IVS) (p < 0.001), the posterior wall of the left ventricle (p < 0.001), and the size of the right ventricle (p < 0.001). It was revealed that in Gr1 the frequency of myocardial hypertrophy with an interventricular septum thickness of 5 mm or more is 30.8 %, which is statistically significantly higher in comparison with Gr2 (1.8 %, F = 0.115, p < 0.001). When assessing the blood flow using a pulse-wave Doppler study, the manifestations of the diastolic dysfunction in Gr1 were revealed. The E/A ratio for the flow through the mitral valve in Gr1 was 0.9 (0.8–1.1), in Gr2 – 1.2 (1.0–1.4), p = 0.043. The study confirmed a lower frequency of registration of myocardial hypertrophy with good glycemic control during pregnancy (p < 0.05). Direct correlations between the average level of glycated hemoglobin in mothers and the IVS thickness (r = 0.374, p < 0.05) and the posterior wall of the left ventricle (r = 0.293, p < 0.05) of their newborns were observed in infants in Gr1.The use of pump insulin therapy in pregnant women with type 1 diabetes allowed a statistically significant reduction in the frequency of hypertrophy of the left ventricle in infants in the neonatal period.Diabetes mellitus type 1 in the mother determines not only the risk of congenital heart defects, but also hypertrophic changes in the myocardium, contributes to the diastolic dysfunction in this group of children. The achievement of target levels of glycated hemoglobin during pregnancy, using pump insulin therapy, provides a lower frequency of registration of ventricular septal hypertrophy. The revealed statistically significant differences in the IVS thickness and the posterior wall of the left ventricle in infants born to mothers with type 1 diabetes should be taken into account by doctors in the system of organizing medical care in inpatient settings and at the stage of dispensary observation.

Background: Congenital heart disease is a condition of heart anomaly and or disfunction of heart since birth. The most common congenital heart disease is Tetralogy Of Fallot (TOF). The disorder has four features, a ventricular septal defect, aortic overriding, stenosis pulmonary, and hypertrophy right ventricular. Method: This review aimed to talk about oral manifestations and discuss options of several oral and dental management in children with TOF. Result: Oral and dental treatment of pediatric patient with cardiovascular disease is important to be carried out with the risk of bacterial endocarditis. Conclusion: Oral and dental management in a child with congenital heart disease is very important. Main point of dental management are dental health education, preventive dental treatment and control periodic after dental treatment.

Objective: to study the clinical manifestations of the LEOPARD syndrome in representatives of one family, to define the peculiarities of cardio pathologies in dynamic observation. Methods and materials: long-term observation of patients with LEOPARD syndrome, study of family anamnesis, analysis of medical histories. Patients were consulted by a geneticist. In two people, the diagnosis was confirmed with a molecular-genetic method. Results. We are monitoring a family, 6 representatives of which in four generations have LEOPARD syndrome. The disease is maternally transmitted. Patients of all generations have dwarfism, multiple lentigo, “triangular” face, hypertelorism of the eyes, a peculiarity of the position of the auricles, pterygoid scapula. The patients – third-generation relatives and probands – sisters of 5 and 7 years old, various pathologies of the cardiovascular system were revealed, such as: pulmonary artery stenosis, ventricular septal defect, ventricular septal hypertrophy, mitral valve prolapse. Representatives of the third generation have a medical history of hypogonadism, primary amenorrhea, uterine fibroids, nervous system malfunctions (convulsions, syncope), and learning difficulties. None of the members of this family have chest deformation and deafness typical for LEOPARD syndrome. Conclusion: LEOPARD syndrome is characterized by significant polymorphism of clinical manifestations, even in members of the same family. Correct assessment of the phenotypic features of LEOPARD syndrome enables to promptly assume that the patient has congenital heart disease, hypertrophic cardiomyopathy, endocrine disorders, to prescribe adequate treatment, and prevent possible complications.

CHARACTERISTICS OF CARDIAC AMYLOIDOSIS WITH ASYMMETRIC SEPTAL HYPERTROPY

Abstract A 72-year-old woman was admitted for acute heart failure. The echocardiography revealed moderate depression of the left ventricular ejection fraction. Coronary disease was excluded by coronarography. Cardiac magnetic resonance showed predominantly left ventricular septal hypertrophy and severe depression of the left ventricular systolic function. There was also a bright, multifocal and patchy late gadolinium enhancement with subendocardial, mesocardial and subepicardial involvement, suggestive of sarcoidosis. Biochemical study, thoracic computed tomography and positron emission tomography were inconclusive for extra-cardiac sarcoidosis. Therefore, an endomyocardial biopsy was performed. The procedure was complicated by the development of complete atrioventricular block, requiring implantation of a cardiac resynchronization pacing device. A few days after device implantation, the patient developed fever. The echocardiography revealed extensive vegetations, and thus the diagnosis of a device-associated infective endocarditis was made. Even though antibiotic therapy was promptly started, the patient ended up dying. Biopsy results revealed lymphocytic myocarditis. This case is paradigmatic because it shows how the etiologic diagnosis of dilated cardiomyopathy can be challenging. Non-invasive diagnostic exams may not provide a definite diagnosis, requiring an endomyocardial biopsy. However, the benefits versus risks of such procedure must always be carefully weighted.

Background: Tetralogy of fallot is one of the congenital cyanotic heart disease that is often found in children. The disorder has four features, a ventricular septal defect (VSD), aortic overriding, infundibulary stenotic, and hypertrophy right ventricular. Like other congenital heart disease, tetralogy of fallot sometimes related to fatal complications, such as bacterial endocarditis which was related to dental infections. Anesthetic management in tetralogy of Fallot is often described in patients with known cardiac disease. Perioperative considerations include preoperative preparation for surgery, intraoperative anesthetic management, and common postoperative issues in the intensive care unit.Case: A three-year-old boy had history of Tetralogy of Fallot. He has many severe early childhood caries. From the physical examination, many severe caries and roots gangrene was found in both jaws. He was planned to get teeth extraction under general anesthesia.Discussion: Tetralogy of fallot (TOF) is a congenital cyanotic heart disease that is often found in children, approximately around of 7–10% from overall congenital heart disease in children. Children with TOF have an increased risk of bacterial endocarditis. Invasive procedure was performed under general anesthesia. Patient was successfully operated under general anesthesia.Conclusion: Tetralogy of Fallot is a congenital cyanogenic heart disease that is a challenge for anesthetist. General anesthesia is the best suitable anesthetic technique in instable patient.

Hypertrophic Left Ventricle With Small Cavity and Severe Aortic Angulation: A Dangerous Association in Case of Transcatheter Aortic Valve Replacement

Left ventricular (LV) septal hypertrophy in aortic stenosis raises diagnostic and therapeutic questions. However, the etiology and clinical consequences of this finding have not been well studied. The aim of this study was to perform a morphologic evaluation of the LV in aortic stenosis and to investigate the contributing factors and consequences of septal hypertrophy. Patients with moderate or severe aortic stenosis were prospectively enrolled. Patients with previous myocardial infarction, wall motion abnormalities, at least moderate valvular regurgitation, known cardiomyopathy, an LV ejection fraction of less than 50%, and age younger than 65 years were excluded. Forty-one patients underwent a final analysis. Septal hypertrophy (LV septal wall thickness ≥15 mm) was confirmed in 21 of 41 patients. The septal hypertrophy group had higher peak aortic valve velocity, a higher diabetes mellitus rate, and a higher rate and longer duration of hypertension than those without septal hypertrophy. The peak aortic valve velocity (odds ratio, 7.1; 95% confidence interval, 1.4-37.1) and diabetes mellitus (odds ratio, 7.4; 95% confidence interval, 1.2-46.2) were the significant factors associated with septal hypertrophy by multivariate analysis. Intraventricular conduction disturbance on electrocardiography was more frequent in the septal hypertrophy group (P = .021). Left ventricular septal hypertrophy was commonly observed in elderly patients with aortic stenosis, and a higher aortic valve velocity, hypertension, and diabetes mellitus were associated factors. Intraventricular conduction disturbance occurred more often in patients with septal hypertrophy than those without, which implies the pathophysiologic consequence. Further studies are needed to determine the impact of septal hypertrophy and intraventricular conduction disturbance on the prognosis of patients after aortic valve interventions.

Localized ventricular septal hypertrophy, also known as idiopathic hypertrophic subaortic stenosis or idiopathic hypertrophic subaortic septal obstruction (IHSS), can create severe ventricular outflow obstruction. This often results in a high sub-aortic pressure gradient with potentially lethal symptoms. In 1960, Braunwald described the hemodynamic characteristics of IHSS, and thereafter, Morrow developed a trans-aortic approach to resect a large part of the ventricular septum, enlarging the outflow tract. The Morrow operation has remained the gold standard for surgically treating this pathology. However, in patients with a small aortic annulus, a severely hypertrophied septum, and a long anterior mitral leaflet, the trans-aortic approach may be more difficult, resulting in an inadequate resection and/or systolic anterior leaflet motion. The latter usually increases the obstruction and can cause mitral regurgitation. Herein, we describe a minimally invasive trans-left atrial robotic approach to treat IHSS. First, the anterior mitral leaflet is incised radially to reveal the aortic outflow tract and ventricular septum, which are located posteriorly. Thereafter, a deep "block" of septum is excised, beginning at the right valve cusp nadir and continued counterclockwise toward the left fibrous trigone. This excision is extended to the anterior papillary muscle base, where any septal connections must be divided. Subsequently, the anterior leaflet is re-suspended and the repair is completed with a flexible annuloplasty band. If necessary, the anterior leaflet can be augmented with a pericardial patch. The "wristed" robotic instruments and magnified 3-D vision definitely facilitate an adequate septal resection and anterior papillary muscle mobilization. Moreover, it is possible that this fine control helps to reduce complications, such as heart block or a ventricular septal defect.

Introduction. Tetralogy of Fallot is a congenital heart disease and the most common cyanotic heart defect in children. It is clinically characterized by a ventricular septal defect, pulmonary stenosis, overriding aorta over ventricular septal defect and right ventricular hypertrophy. There is little or no information about the oral manifestations in patients with this pathology. A report and discussion of a pediatric patient diagnosed with Tetralogy of Fallot, its clinical manifestations, oral findings and dental management are presented. Case Report. A four-year-old male patient diagnosed with Tetralogy of Fallot and epileptic attacks. The patient has deciduous teeth with many severe early childhood caries, stomatitis and cyanotic mucous, radicular remains, periapical abscess and noticeable enamel hypoplasia. Conclusions. In agreement with other authors, children with systemic diseases such as Tetralogy of Fallot have a higher rate of caries, poor oral hygiene, high susceptibility to other infections and bacterial endocarditis, cyanotic mucous membranes and enamel hypoplasia. Primary prevention is critical, proper dental hygiene, regular dental check-ups and the use of antibiotic prophylaxis are particularly important, especially in high-risk patients.

Aim. To study possible variants of changes in structural and functional parameters of central hemodynamics in liver cirrhosis classes A, B, C (Child– Pugh) to improve the early diagnostics of extrahepatic complications. Material and methods. Parameters of central hemodynamics were studied in 107 patients with liver cirrhosis of viral etiology classes A, B, C (ChildPugh) with different levels of serum interleukins (interleukin-2, interleukin-6, tumor necrosis factor alpha). Results. Significant changes in the central hemodynamics parameters were not revealed in liver cirrhosis of classes A and B. In patients with liver cirrhosis of class С the following significant changes of the left and right heart were found: thickening of the interventricular septum and left ventricular posterior wall up to 12.9Ѓ}1.3 and 13.5Ѓ}1.4 mm respectively; increase in left atrium up to 43.1Ѓ}4.7 mm; right ventricular dilatation up to 38.6Ѓ}4.1 mm and pulmonary artery up to 35.7Ѓ}3.1 mm with an increase in pressure in it up to 35.7Ѓ}3.1 mm Hg. The rate and variants of changes in structural and functional parameters of central hemodynamics correlated with the stages of the liver cirrhosis compensation and the interleukins serum levels. Conclusion. Changes in parameters of central hemodynamics in liver cirrhosis depends on the stage of compensation. The most pronounced systolic and diastolic myocardial dysfunctions were observed in cirrhosis Class C, with high levels of portal pressure and high concentrations of serum interleukins. Concentric remodeling of the left ventricular and isolated ventricular septal hypertrophy were the worst types of the left ventricular remodeling. These variants of ventricular geometry were accompanied by the most severe impairments of diastolic function.