Selective contrast echocardiography in percutaneous transluminal septal myocardial ablation in an elderly patient with left ventricular concentric hypertrophy

Hemodynamic stress and microscopic remodeling

BACKGROUD

Heart responds to physiologic and pathologic conditions and sympathetic drive plays an important role. It has been documented that LV base is more dominantly affected by sympathetic drive compared to the other regions. LV base is more dominantly exposed to wall stress in the initial period of remodeling due to pressure-overload, since LV cavity is the largest at base. Basal septal hypertrophy (BSH) in cross-sectional data is associated with the early phase of hypertensive heart disease. BSH was confirmed by 3rd generation microscopic ultrasound in small animals. BSH as the closest location to increased afterload could be detected in variety of stress stimuli and result in a huge septal hypertrophy in advance cases possibly related to earlier exposure of hemodynamic stress to septal wall.

CONCLUSION

Effective geometric and functional evaluation of initial remodeling due to hemodynamic stress is important according to both human and animal data. These findings possibly contribute to early recognition of adaptive phase of hypertensive remodeling and more effective management in a timely fashion.

Sigmoid-shaped ventricular septum causing mid-ventricular obstruction: report of 2 cases

Sigmoid-shaped ventricular septum (SSVS) is frequently observed in elderly patients, but association of mid-ventricular obstruction is rare. In this report, we describe 2 patients with SSVS who had mid-ventricular obstruction and intracavity pressure gradient detected by echocardiography and cine magnetic resonance imaging. Attention should be paid to SSVS because it may cause clinically significant hemodynamic derangements related to mid-ventricular obstruction.