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1/329. Pacemaker therapy in a pediatric patient with hypertrophic obstructive cardiomyopathy and rapid intrinsic atrioventricular conduction.

    A 13-year-old boy with hypertrophic obstructive cardiomyopathy was treated with dual-chamber pacing after severe progression of left ventricular outflow tract obstruction and of clinical symptoms despite drug therapy. Rapid intrinsic atrioventricular conduction was overcome and complete preexcitation of the septum achieved by omitting atrial sensing and programming constant atrial pacing with a short atrioventricular delay of 70 msec. After 8 weeks of therapy, a reduction of the left ventricular outflow tract gradient from 125 to 16 mmHg and remodeling of the left ventricle were demonstrated.
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ranking = 1
keywords = outflow, obstruction
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2/329. Discrete subaortic valvular stenosis: the clinical utility and limitations of transesophageal echocardiography.

    Transesophageal echocardiography (TEE) is a useful technique in the diagnosis and intraoperative assessment of discrete subaortic stenosis (DSS). It allows clear visualization of the subaortic membrane, which may be missed by transthoracic echocardiography, differentiates DSS from other causes of left ventricular outflow tract obstruction, and accurately detects the presence of associated aortic regurgitation and bacterial endocarditis. Limitations in its use include inadequate visualization of the left ventricular outflow tract by TEE in the presence of a prosthetic mitral valve or mitral annular calcification, and improper alignment of the Doppler cursor across the outflow tract.
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ranking = 1.4853034589272
keywords = outflow, obstruction
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3/329. diagnosis of accessory mitral valve tissue by transesophageal echocardiography.

    Accessory mitral valve tissue is a rare cause of intracardiac mass and subvalvular left ventricular outflow tract obstruction. The preoperative diagnosis of this congenital anomaly has been facilitated by transthoracic two-dimensional and Doppler echocardiography. However, transthoracic two-dimensional echocardiography cannot identify or correctly diagnose all cases of accessory mitral valve tissue. We report a patient in whom an intracardiac mass detected by transthoracic echocardiography was definitively diagnosed as accessory mitral valve tissue by transesophageal echocardiography.
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ranking = 0.51469654107282
keywords = outflow, obstruction
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4/329. Aortoventriculoplasty after a prior posterior root enlargement (Manougian): case report.

    A patient with congenital bicuspid aortic stenosis had an open commissurotomy followed 3 years later by a Manougian's operation along with an aortic valve replacement. Nine years later, due to residual aortic stenosis, a Konno's anterior root enlarging procedure with an aortic valve replacement was successfully done. Good relief of aortic and subaortic stenosis and the absence of significant gradient across the left ventricular outflow tract led us to believe that successful and effective relief could be obtained by adding a Konno-type of enlargement to a previously performed posterior enlargement procedure.
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ranking = 0.48530345892718
keywords = outflow
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5/329. Echocardiographic diagnosis of left ventricular outflow tract obstruction caused by an acquired subaortic membrane after mitral valve replacement.

    Although an acquired subaortic membrane has been reported as a cause of left ventricular outflow tract (LVOT) obstruction in various clinical settings, it previously has not been reported after mitral valve surgery. We describe 3 cases of acquired LVOT obstruction that resulted from development of a subaortic membrane after mitral valve replacement. This report emphasizes the role of an acquired subaortic membrane in LVOT obstruction after mitral valve replacement, the use of echocardiography in diagnosing this condition, and the importance of early intervention.
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ranking = 2.6322688696554
keywords = outflow, obstruction
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6/329. Critical obstruction of the right ventricular outflow tract by a primary hemangioendothelioma in a seven month old.

    A 7-month-old presented with failure to thrive and a murmur. echocardiography demonstrated a large mass in the right ventricular outflow tract, extending through the pulmonary valve. During anaesthetic induction this caused critical obstruction of the outflow tract and cardiac arrest. Pathological diagnosis showed the lesion to be a primary hemangioendothelioma. Despite surgical excision and steroid therapy, the mass continued to grow for a period of 8 weeks, but then began to regress spontaneously.
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ranking = 3.0587861642913
keywords = outflow, obstruction
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7/329. Fatal neonatal hypertrophic cardiomyopathy with severe stenosis of the right ventricular outflow tract: echocardiographic diagnosis and potential therapy.

    We discuss the clinical course of aneonate with idiopathic hypertrophic cardiomyopathy who showed rapid progression of stenosis of the right ventricular outflow tract and reduction in size of the right ventricular cavity due to thicken ing of the ventricular septum. Medical treatment proved unsuccessful. We suggest that balloon atrial septostomy combined with construction of a Blalock-Taussig shunt may be effective in view of the hemodynamics, which mimic pulmonary atresia with intact interventricular septum.
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ranking = 2.4265172946359
keywords = outflow
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8/329. Unruptured congenital aneurysm of the sinus of valsalva presenting with pulmonary stenosis.

    Congenital aneurysm of the sinus of valsalva is a rare cardiovascular anomaly. It is usually silent until rupture occurs. The natural history of unruptured aneurysm of the sinus of valsalva is still not clear, and the therapeutic strategy is uncertain. Here we reported a case of unruptured aneurysm of the sinus of valsalva which was correctly diagnosed before invasive diagnostic procedures. A 30-year-old female noted mild palpitation and dyspnea for 1 month. Physically, a grade 3/6 systolic ejection murmur at upper left sternal border was detected. echocardiography revealed dilatation and irregular protrusion of the right sinus of valsalva encroaching on right ventricular outflow tract to cause obstruction. With these findings, unruptured aneurysm of the sinus of valsalva with pulmonary stenosis was diagnosed. cardiac catheterization and angiography confirmed the diagnosis. The aneurysm was repaired with a Dacron patch with good results. It is concluded that sinus of valsalva aneurysm can be diagnosed by echocardiography before its rupture so as to render a proper management for this potentially life-threatening anomaly.
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ranking = 0.51469654107282
keywords = outflow, obstruction
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9/329. Left-ventricular inflow obstruction due to a dilated coronary sinus mimicking cor triatriatum.

    Persistence of the left superior vena cava with drainage to the coronary sinus is a common congenital anomaly. We report an infant with such a malformation associated with marked enlargement of the coronary sinus, which produced partial supramitral obstruction and consequently impairment to the left-ventricular inflow. The patient pre-sented with cardiac failure in infancy and features mimicking cor triatriatum. Surgical relief of the supramitral obstruction resulted in immediate reversal of the pulmonary hypertension, with clinical improvement. This rare entity, only once previously reported, is an unusual cause of pulmonary hypertension in infancy.
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ranking = 0.1763584928739
keywords = obstruction
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10/329. Congenital subaortic stenosis by accessory mitral valve tissue, recognition and management.

    Accessory mitral valve tissue as the single cause for left ventricular outflow tract obstruction is a very rare cardiac malformation in normally connected hearts. We report a case in which this condition was present as single cause for left ventricular outflow tract obstruction. The surgical technique is described and a review of the literature presented.
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ranking = 1.0293930821456
keywords = outflow, obstruction
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