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One more cause for dynamic LVOT obstruction : Abnormal Aortic angle ?

Posted Feb 22 2011 10:57pm

Inter-ventricular septum is generally in parallel alignment with Anterior aspect of root of aorta.

Have a look at this echo form a 65year old man

Note the classical bend of basal IVS encroaching the LVOT. Aortic valve opens normally.

 

The basal septum Projecting into LVOT

Pseudo LVOT gradient. It was about 25mmhg which is not significant.

 

 

  • Sigmoid shaped IVS can  cause a unique  LVOT  profile .
  • Present in elderly . The exact mechanism and  mechanical and hemodynamic   implications are not known .
  • It can rarely cause  dynamic LVOT obstruction.
  • When these patients develop Infero posterior MI there could be further collapse of IVS into LVOT .

Relationship between Aortic angle , Hypertension, HCM

Many of the HCM patients may show similar features .When ASH is confined only to basal IVS. HCM should not be diagnosed instead it is  often a defect of aorta /IVS alignment .

Abnormal  aortic angle  with that of IVS  may  make the IVS appear sigmoid.

If  patients  with abnormally angled aorta develop hypertension ASH and sigmoid septum is  more pronounced .

IVS dragging by mass effect  on aortic root is possible and Aortic regurgitation may ensue

Reference


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