Provocation of clinically significant left ventricular outflow tract obstruction by postural change in patients with sigmoid septum
Provocation of clinically significant left ventricular outflow tract obstruction by postural change in patients with sigmoid septum
复制标题
乙状结肠间隔患者体位改变引发具有临床意义的左心室流出道梗阻
DOI：
10.1007/s12574-018-0372-x
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Sata Masataka
中科院分区：
文献类型：
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作者：
Hirata Yukina;Yamada Hirotsugu;Kusunose Kenya;Nishio Susumu;Torii Yuta;Horike Yuki;Sata Masataka
讨论乙状间隔在老年人中常见，被认为与由于年龄增长和动脉粥样硬化改变导致的主动脉延长有关[1]。这种情况很少出现临床问题，除非伴有左心室流出道梗阻[2]。据报道，LVOT梗阻有时并不明显，而是由运动、Valsalva手法、脱水、贫血或用药引起的[3]。在病例1中，将左侧卧位改为脊柱位置可能会减少前负荷，从而增加左冠状动脉流出道梗阻。Yamaguchi等人[4]报道了2例复发性晕厥患者因直立倾斜导致的LVOT梗阻，这与我们的病例2相似。Kobayashi等人[5]最近评估了患者左心室流出道压力梯度增加的原因，乙状结肠间隔仅占总数的4%。然而，常规检查中未进行激发试验，在各种应激状态下确诊为潜在性LVOT梗阻的患者数量可能大幅增加。当我们进行超声心动图检查时，我们需要听取患者在何时以及如何出现症状的抱怨，并使用适当的负荷方法，包括Valsalva动作和体位改变。
DiscussionSigmoid septum is observed frequently in elderly which is thought to be associated with elongation of the aorta due to aging and atherosclerotic changes [1]. This condition rarely becomes clinically problematic unless accompanied by LVOT obstruction [2]. It has been reported that the LVOT obstruction sometimes is not overt but provoked by exercise, a Valsalva maneuver, dehydration, anemia or drug administration [3]. In case 1, changing to left decubitus position to spine position might reduce preload, which enhanced LVOT obstruction. Yamaguchi et al.[4] reported that head-up tilt induced LVOT obstruction in 2 patients with recurrent syncope, which is similar with our case 2. The mechanism of LVOT obstruction is diverse. Kobayashi et al.[5] recently assessed the cause of an increased LVOT pressure gradient in patients, sigmoid septum was only 4% of the total. However, provocation test did not perform in the routine examination, the number of patients with latent LVOT obstruction diagnosed under various stress may substantially increase. When we conduct echocardiographic examination, we need to listen to patients’ complaints at when and how their symptoms appear, and to use the appropriate loading method including Valsalva’s maneuver and posture change.