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11/178. Simultaneous operative correction of aortic valve stenosis and idiopathic hypertrophic subaortic stenosis.

    Idiopathic hypertrophic subaortic stenosis (IHSS) may coexist with aortic valve stenosis (AVS). This combination of lesions is uncommon and may not be identified by the usual preoperative clinical evaluation and laboratory studies including cardiac catheterization. Surgical relief of AVS without concomitant septal myectomy to relieve unrecognized underlying IHSS may be followed by a low cardiac output, evidence of residual outflow tract obstruction, and death. echocardiography (ECHO) will accurately identify IHSS and should be performed in all patients suspected of having AVS. This report describes the first three patients in whom the preoperative diagnosis of both AVS and IHSS was made and who subsequently had both lesions corrected at the same operation. All patients survived operation. The outflow tract gradient was abolished in two patients and significantly reduced in the third. All patients with this combination of lesions should be offered operation for the same indication as isolated aortic valve stenosis. The operation should include a septal myectomy as well as relief of the aortic valve stenosis.
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ranking = 1
keywords = subaortic, stenosis
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12/178. recurrence of left ventricular outflow tract obstruction after left anterior descending coronary artery revascularization in a patient with hypertrophic obstructive cardiomyopathy.

    A patient with known hypertrophic obstructive cardiomyopathy presented with an anteroseptal myocardial infarction which resulted in the disappearance of his subaortic pressure gradient. Surgical revascularization of his left anterior descending coronary artery after the viability of his myocardium had been documented led to the recurrence of his left ventricular outflow tract obstruction and subaortic pressure gradient.
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ranking = 0.37220698014121
keywords = subaortic
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13/178. Percutaneous septal ablation for hypertrophic cardiomyopathy and mid-ventricular obstruction.

    AIMS: Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion is a new treatment option in symptomatic patients with hypertrophic cardiomyopathy and subaortic, SAM-associated obstruction. We report on a patient with mid-ventricular obstruction and echocardiographic-guided reduction of septal hypertrophy. methods AND RESULTS: A 52-year-old woman with NYHA class III and recurrent exercise-induced syncope suffered from hypertrophic cardiomyopathy with mid-ventricular obstruction. She had a systolic gradient of 71 mmHg at rest and 153 mmHg post-extrasystole, and diastolic inflow gradient of 20 mmHg. Echo-guided percutaneous transluminal septal myocardial ablation with occlusion of the fourth septal branch resulted in acute reduction and final elimination of systolic, as well as diastolic resting and provocable gradients. Complications were not seen. At 3 months' follow-up the patient was asymptomatic and without further syncopes. CONCLUSIONS: Echocardiographic-guided percutaneous transluminal septal myocardial ablation is able to reduce gradients in hypertrophic cardiomyopathy and mid-ventricular obstruction with consecutive improvement of symptoms.
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ranking = 0.1861034900706
keywords = subaortic
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14/178. Fractional flow reserve in a patient with intermediate coronary stenosis and hypertrophic cardiomyopathy.

    We discuss the case of a 61-year-old male patient with hypertrophic cardiomyopathy and chest pain on exertion. coronary angiography and intravascular ultrasound revealed an intermediate stenosis in the proximal site of the left anterior descending artery, while Tc-99m myocardial scintigraphy revealed exercise-induced myocardial ischemia in the anteroseptal wall and apical portion. Flow velocity-derived coronary flow reserve (CFR) and pressure-derived fractional flow reserve (FFRmyo) were both low (1.1 and 0.59), suggesting that the stenosis was functionally significant. Directional coronary atherectomy greatly improved the FFRmyo (0.99), the scintigraphic findings, and anginal pain but did not improve the CFR (1.2). FFRmyo was useful in assessing the functional significance of an equivocal coronary stenosis and its interventional resolution.
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ranking = 0.040531487294073
keywords = stenosis
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15/178. Combined hyertrophic subaortic stenosis and calcific aortic valvular stenosis.

    A well documented case of combined hypertrophic subaortic stenosis and calcific aortic stenosis is reported. Detection of multilevel involvement in cases of left ventricular outflow obstruction requires a high index of suspicion and precise hemodynamic and angiographic documentation. Careful analysis of the total data base is necessary for proper management of the patient. The pathogenesis of this combined lesion is unclear: Asymmetrical septal hypertrophy may occur as a consequence of the valvular stenosis, or it may be that abnormal leaflet motion in patients with hypertrophic obstruction produces leaflet thickening, calcification, deformity and stenosis.
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ranking = 1
keywords = subaortic, stenosis
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16/178. Surgical correction of unusual double-outlet right ventricle.

    This paper presents the case history of an 8-year-old girl who had total situs inversus and double-outlet right ventricle with pulmonary stenosis and severe tricuspid insufficiency in the presence of dextrocardia with ventricular discordance. A successful repair was performed using the Rastelli technique in conjunction with replacement of the tricuspid valve with a Bjork-Shiley prosthesis. The postoperative course was uneventful, and follow-up catheterization revealed a good operative result. However, the patient died suddenly during an emotionally upsetting period about two months after the operation. Postmortem examination revealed only signs of moderately severe cardiac decompensation. Some anatomical and embryological comments are made.
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ranking = 0.0057902124705819
keywords = stenosis
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17/178. Primitive ventricle with acquired subpulmonary stenosis.

    The course and natural history of two children aged 1 yr and 5 yr with primitive ventricle with outlet chamber and normally related great arteries are described. They initially presented as ventricular septal defect with increased pulmonary blood flow and subsequently developed 'cyanotic attacks', chronic cyanosis and diminished pulmonary flow by acquiring subpulmonary obstruction of the bulboventricular foramen. Both had successful surgical treatment utilizing their own normal pulmonary valves by connecting the right atrium to the right ventricular outflow, with a Dacron conduit in one, and in the other by detaching the pulmonary artery and valve from the rudimentary outflow chamber and anastomosing it directly to the right atrial appendage. Changing morphology and its effect on function are discussed.
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ranking = 0.023160849882327
keywords = stenosis
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18/178. situs inversus totalis associated with subaortic and subpulmonic stenosis.

    The unusual occurrence of total situs inversus and idiopathic hypertrophic subaortic stenosis with the demonstration of right and left heart dynamic obstruction in one patient is presented. The fact that the patient was known to have a rare abnormality (total situs inversus) and the presenting symptom being angina pectoris, may have obscured the diagnosis of IHSS and emphasized the value of comprehensive evaluation of patients. The documentation of right ventricular dynamic obstruction, in addition to obstruction of the left side of the heart, was facilitated by the use of simultaneous pressure recordings in the pulmonary artery and in the body of the right ventricle. The angina-like pain was secondary to left ventricular outflow obstruction, rather than to coronary disease.
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ranking = 0.95946851270593
keywords = subaortic, stenosis
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19/178. Idiopathic hypertrophic subaortic stenosis in a patient with mirror-image dextrocardia.

    A 42-year-old man with mirror-image dextrocardia was found to have idiopathic hypertrophic subaortic stenosis. The coexistence of these uncommon congenital cardiovascular anomalies was previously reported in only one patient.
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ranking = 0.95946851270593
keywords = subaortic, stenosis
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20/178. Intracoronary beta radiation for in-stent restenosis in a patient with percutaneously treated hypertrophic cardiomyopathy and coronary artery disease.

    Atherosclerotic coronary artery disease is not uncommon in elderly patients with hypertrophic cardiomyopathy. These disease entities are increasingly being treated with catheter-based techniques. We report an elderly symptomatic woman treated simultaneously with coronary angioplasty, stenting and transcoronary ablation of septal hypertrophy who developed in-stent restenosis 7 months later, and was then treated with brachytherapy. Six-month and 1-year post-brachytherapy follow-up revealed a good angiographic result and adequate symptomatic relief. This is the first report describing the feasibility and efficacy of intracoronary beta radiation in a patient with hypertrophic cardiomyopathy.
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ranking = 0.028951062352909
keywords = stenosis
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