P1715 Aortic stenosis with concomitant LVOTO: an alternative treatment to surgery
Notice bibliographique
Résumé
Abstract The dilemma of the patient with both aortic stenosis (AS) and significant left ventricular outflow tract obstruction (LVOTO) is usually managed through conventional surgery. Patients included in TAVI studies are highly selected, and the presence of LVOTO is a common exclusion criteria. Permanent pacing is referred as a possible treatment in medically refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. We report a case of AS and LVOTO that was submitted to transcatheter aortic valve replacement (TAVR) due to high surgical risk, and submitted to a definitive pacemaker implantation after the procedure. This case is about a female patient with 82 years old and a history of a severe aortic stenosis with a significant ventricular hypertrophy that causes LVOTO. She had a previous history of hypertension, dyslipidemia, osteoporosis and breast cancer. The patient presented with angina (grade II in Canadian Cardiovascular Society Angina Grade), dyspnea and weakness (classe II of New York Heart Association functional classification). Transthoracic Echocardiography (TTE) presented with severe aortic stenosis with a basal septal ventricular hypertrophy of 18 millimeters, a systolic anterior motion of the mitral valve (SAM) both conditioning LVOTO (maximal gradient of 75 mmHg at rest) and moderate mitral regurgitation (MR). Coronariography showed no coronary lesions. Transfemoral TAVR was successfully implanted under general anesthesia and transesophageal echocardiography monitoring (TOE). During ballooning pre-dilatation a complete atrioventricular block developed. Immediately after the valve implantation TOE showed a well-positioned prothesis without intra or peri-prosthetic regurgitation but with an intraventricular gradient (IVG) above 50mmHg and a moderate to severe MR. SAM, IVG and MR were medically managed and the patient went to the intensive cardiac unit (ICU) with a IVG of 50mmHg and a moderate MR. In the next 24H in the ICU, the patient had a clinical deterioration and TTE found an increased intraventricular gradient (140 mmHg) and a severe mitral regurgitation. It was decided to implant a Dual Chamber pacemaker (DDD PM) and adjust beta-blocker and fluid therapy. A progressive clinical improvement was observed and clinical stabilization attained after 48H. At discharge (7 days after TAVR), TTE showed decreased intraventricular gradients (30 mmHg at rest, 50 mmHg with Valsalva maneuver), telesystolic SAM and a moderate mitral regurgitation. At 6 moths follow up, patient was free of cardiovascular events and had no symptoms of heart failure. This case shows that TAVR is a safe procedure in patients with LVOTO, but we have to be aware of potentially severe hemodynamic consequences of sudden reduce in after load pressure in these patients. In high risk surgical patients, DDD-PM can accomplish acute and at least medium term clinical and hemodynamic stabilization. Abstract P1715 Figure. Echocardiography images
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,004 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».