Left Ventricle Outflow Obstruction by Reverse-Oriented Tricuspid Semilunar Valve-Like Endocardial Duplicatures

A 57-year-old female had a history of hypertension disease, and one year before her death, her ECG showed signs of left ventricle hypertrophy. She died with signs of heart failure with pulmonary edema development. At autopsy, there was left ventricle hypertrophy (wall thickness: 21 mm). In the left ventricle outflow channel, 15 mm below the aortic valve on the muscular wall, there were three white 1–1.5 mm thick membranous semilunar valve-like structures with the sizes of 9, 7, and 5 mm, with concavities opened into the left ventricle, reducing the outflow area by 21.5%. These structures were hanging on the regular muscular ventricular wall, without any visible fibrous anchoring structure and without formation of commissures, and were composed of fine collagen and elastic fibers. Gross anatomy as well as histological structure was different from the subaortic membrane. The reported accessory reverse-oriented tricuspid semilunar valve-like structure is an unusual finding of a structure in the left ventricular outflow tract, to which we could not find an analogy in the available literature.

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Cardiac hypertrophic risk markers of left ventricle and left atrium in chronic heart failure due to aortic and mitral valve disease

Acta Radiologica ◽

10.1177/0284185120933530 ◽

2020 ◽

pp. 028418512093353

Author(s):

Muhammad Ishtiaq Jan ◽

Riaz Anwar Khan ◽

Naeem Khan ◽

Aisha Mahak ◽

Azhar Ul Haq Ali Shah ◽

...

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Natriuretic Peptide ◽

Left Atrial ◽

Left Ventricular ◽

Left Atrial Enlargement ◽

Left Ventricle Hypertrophy ◽

Atrial Enlargement ◽

The Mean ◽

Ventricle Hypertrophy

Background Chronic valvular heart disease leads to systolic dysfunction and left atrial enlargement that ultimately results in heart failure. Purpose To investigate prognostic importance of Echocardiography and plasma natriuretic peptide levels that increase as a compensatory response and can be used as predictive markers for cardiac hypertrophy. Material and Methods The patients were divided into three groups: 51 with left ventricle hypertrophy due to aortic valve disease; 126 with left atrial enlargement due to mitral valve dysfunction; and 76 with both conditions. Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) plasma levels were measured in all three respective groups showing dilated cardiomyopathy. Results The mean left ventricular end-diastolic dimension at 64.3 ± 1.6 mm ( P < 0.00) and left atrial dimension at 58.3 ± 3.7 mm ( P < 0.00) were significantly high. However, patients with both conditions showed significantly high values for left ventricular end-diastolic dimension (63.3 ± 3 mm, P < 0.00) and left atrial dimension (54.9 ± 4 mm, P < 0.00) when compared with controls. A significant positive correlation was found between plasma natriuretic peptides levels and dilated cardiomyopathy. The mean values of ANP were 173 ± 46.6 pg/mL ( P < 0.00), 140.4 ± 42.4 pg/mL ( P < 0.00), and 295.1 ± 67.5 pg/mL ( P < 0.00), significantly high in all three respective disease groups. The levels of BNP were also significantly high at 189 ± 44.5 pg/mL ( P < 0.00), 166.6 ± 36.6 pg/mL ( P < 0.00), and 323 ± 69.1 pg/mL ( P < 0.00) in the disease groups with left ventricular hypertrophy, left atrial enlargement, and the disease group showing both characteristics, respectively. Conclusion Significant positive associations were found between left ventricle hypertrophy and left atrial enlargement with ANP and BNP.

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Left ventricular hypertrophy: differential diagnosis

Endovascular Neuroradiology ◽

10.26683/2304-9359-2019-4(30)-49-58 ◽

2020 ◽

Vol 30 (4) ◽

pp. 49-58

Author(s):

N.M. Nosenko ◽

D.V. Shchehlov ◽

M.Yu. Mamonova ◽

Ya.E. Kudelskyi

Keyword(s):

Magnetic Resonance Imaging ◽

Hypertrophic Cardiomyopathy ◽

Magnetic Resonance ◽

Left Ventricle ◽

Left Ventricular Hypertrophy ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Resonance Imaging ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy

There are some imaging methods for the diagnosis of left ventricular hypertrophy. Such as echocardiography, computed tomography, magnetic resonance imaging. These methods help to identify changes at different stages, evaluate the prognosis, stratify the risk and differential diagnosis.The left ventricle hypertrophy is a condition that may be due to physiological adaptation due to overload. For example, in patients with arterial hypertension, in athletes, and so on. Left ventricle hypertrophy may also be associated with a change in the actual structure: for example, with hypertrophic cardiomyopathy.Signs of left ventricle hypertrophy by echocardiography are a very significant predictor of mortality in patients with arterial hypertension in the general population. The presence of left ventricle hypertrophy by echocardiography is a high cardiovascular risk for the patient.It is important to diagnose diseases with a high risk of sudden cardiac death on time. One of these diseases is hypertrophic cardiomyopathy. A clinical diagnosis of hypertrophic cardiomyopathy is impossible without visualization. Therefore, the European Association of Cardiovascular Imaging recommends a multimodal approach in examining patients with hypertrophic cardiomyopathy.Сomputed tomography, echocardiography, and magnetic resonance imaging are used to diagnose which patient’s hypertrophy is pathological or physiological. The choice of which method to use depends on the diagnostic task, and also on the specific advantages and disadvantages of the method. Different visualization methods should be considered complementary, not competing. It is also important to choose a particular imaging technique given its diagnostic value, availability, benefits, risks and costs.

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Gender differences of left ventricular remodeling in patients with chronic heart failure

Kazan medical journal ◽

10.17816/kmj1514 ◽

2014 ◽

Vol 95 (3) ◽

pp. 362-366

Author(s):

G M Dadashova

Keyword(s):

Heart Failure ◽

Gender Differences ◽

Heart Disease ◽

Chronic Heart Failure ◽

Left Ventricle ◽

Ischemic Heart Disease ◽

Left Ventricular ◽

Ischemic Heart ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy

Aim. To determine the gender differences in risk factors of left ventricular remodeling in patients with chronic heart failure associated with arterial hypertension and coronary heart disease. Methods. The study included 112 patients aged 45 to 60 years with myocardial scaring after myocardial infarction and functional class I-III of heart failure by NYHA. Patients were distributed to 2 groups: 1st included 60 males (mean age 54.8±3.3 years), 2nd - 52 females (mean age 55.8±3.1 years). To assess the cardiac function, all patients underwent echocardiography (B- and M-modes). Models of left ventricle architectonics were identified according to such parameters as left ventricle wall relative thickness index and left ventricular mass index. Results. Leading causes for heart failure in female patients were hypertension (50% of cases) and ischemic heart disease (23.1% of cases, 79.5% of ischemic heart disease cases were not associated). In males, ischemic heart disease was the leading reason for chronic heart failure (78.3% of cases, among them 80.9% with a history of survived myocardial infarction). In females, chronic heart failure was more often associated with isolated diastolic dysfunction (78.8% of cases versus 65% in males, p 0.05), and left ventricle ejection fraction was stable. Unfavorable types of left ventricle remodeling in terms of prognosis were more common among females, including eccentric left ventricle hypertrophy (67.3% of cases versus 53.3% in males, p 0.05) and concentric left ventricle hypertrophy (21% of cases versus 18.3% in males, p 0.05). Conclusion. There are gender differences in patients with chronic heart failure: prevalence of hypertension in women, and coronary heart disease in men; higher rate of isolated diastolic dysfunction prognostically unfavorable types of left ventricle remodeling (eccentric and concentric left ventricle hypertrophy) in females.

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Cardiovascular risk and unproportional high weight of left ventrical myocardium in climacteric women

Kazan medical journal ◽

10.17816/kmj1504 ◽

2014 ◽

Vol 95 (3) ◽

pp. 315-322

Author(s):

A R Sadykova ◽

A R Shamkina ◽

R I Gizyatoullova

Keyword(s):

Left Ventricle ◽

Arterial Hypertension ◽

Left Ventricular Mass ◽

Target Organ Damage ◽

Organ Damage ◽

Left Ventricular ◽

Left Ventricle Mass ◽

Ventricular Mass ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy

Aim. To study the distribution of cardiovascular risk factors, target organ damage, associated clinical conditions and to stratify the 10-year risk of arterial hypertension complications in menopausal females depending on presence of inappropriately high left ventricular mass. Methods. 107 females from city of Kazan aged 42-59 years entered the study, including 11 women with normal blood pressure, 16 patients with high normal blood pressure, and 80 patients with hypertension according to All-Russia scientific Society of Cardiologists classification (2010) with disease duration of 0-34 years. Mean age of patients with hypertension was 51.4±4.0 years. Patients with secondary hypertension were excluded from the study. All patients underwent a questionnaire survey, physical examination, biochemical blood test, ECG, echocardiography, and cervical extracranial vessel ultrasonography. Actual left ventricle mass was calculated according to R.B. Devereux et al. (1977) and was adjusted to the body surface area. Proper left ventricle mass was defined by G. Simone et al. (1998). Disproportion coefficient was calculated as a ratio of actual left ventricle mass to proper left ventricle mass. Left ventricle hypertrophy was diagnosed using the Sokolow-Lyon index and left ventricle mass index ≥ 110 g/m2 (Echo-signs of left ventricle hypertrophy). Results. In menopausal women, inappropriately high left ventricular mass was associated with significantly (р 0.05, Fisher exact test) higher frequency of obesity, especially its abdominal type, as well as target organ damage, including Echo-signs of left ventricle hypertrophy, very high added 10-year risk of developing arterial hypertension complications. It was also associated with significantly (р 0.05, the U-criterion) higher mean values of waist circumference, waist to hip circumference ratio, body mass index, total number of damaged target organs and 10-year risk for developing arterial hypertension complications. Conclusion. Distinguishing the patients with inappropriately high left ventricular mass among menopausal women is important for planning the measures to prevent cardiovascular events.

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Hormonal Response to Incremental and Continuous Exercise in Cyclists with Left Ventricle Hypertrophy

Journal of Human Kinetics ◽

10.2478/hukin-2019-0120 ◽

2020 ◽

Vol 71 (1) ◽

pp. 155-166

Author(s):

Rafał Mikołajczyk ◽

Marcin Sikora ◽

Grzegorz Mikrut ◽

Tomasz Zając ◽

Aleksandra Żebrowska

Keyword(s):

Left Ventricle ◽

Left Ventricular ◽

Incremental Exercise ◽

Cardiac Biomarkers ◽

Control Group ◽

Post Exercise ◽

Continuous Exercise ◽

Left Ventricle Hypertrophy ◽

Type Of Exercise ◽

Ventricle Hypertrophy

AbstractThe aim of this study was to assess the effects of incremental and continuous exercise on the concentration of insulin-like growth factor-1 (IGF-1), growth hormone (GH), testosterone (T), and cortisol (C), as well as to investigate whether increased cardiac dimensions in cyclists were related to changes in these hormones and cardiac biomarkers. The study included 30 elite cyclists divided into two groups, i.e., athletes with left ventricle hypertrophy (a LVH group), and a control group (CG) without LVH. The study protocol included performance of a standard incremental exercise (IncEx) test to measure athletes’ maximum power (Pmax), maximum oxygen uptake (VO2max), and lactate threshold (LAT). The IncEx test results were then used to determine the intensity of the continuous exercise (ConEx) test which was performed after the 1-week washout period. Cyclists with LVH and without LVH did not differ in resting hormone concentrations and cardiac biomarkers levels. There was a significant effect of exercise on serum IGF-1 levels (p < 0.05) in the LVH group and a combined effect of the type of exercise and LVH on IGF-1 (p < 0.05). Cyclists with LVH demonstrated higher post exercise T levels recorded in response to exercise compared to the CG (p < 0.01). Significantly higher serum T levels were observed in response to ConEx compared to IncEx in the LVH group and the CG (p < 0.05 and p < 0.05, respectively). In the LVH group, a significant positive correlation between the post-exercise T/C ratio and left ventricular mass index was observed (r = 0.98, p < 0.01). There were no effects of heart hypertrophy on cardiac standard biomarkers. Incremental and continuous exercise caused a marked increase in steroid hormone concentrations and moderate strengthening of insulin growth factors effects. Regular incremental exercise seems to induce beneficial cardiac adaptations via significant increases in the concentration of anabolic factors compared to the same training mode yet with constant exercise intensity.

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Anterolateral muscle bundle of the left ventricle in atrioventricular septal defect: Left ventricular outflow tract and subaortic stenosis

Pediatric Cardiology ◽

10.1007/bf02238408 ◽

1991 ◽

Vol 12 (2) ◽

pp. 83-88 ◽

Cited By ~ 15

Author(s):

H. A. Yvonne Draulans-Noë ◽

Arnold C. G. Wenink

Keyword(s):

Left Ventricle ◽

Septal Defect ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Atrioventricular Septal Defect ◽

Left Ventricular ◽

Outflow Tract ◽

Subaortic Stenosis ◽

Muscle Bundle ◽

Left Ventricular Outflow

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Echocardiographic assessment of the aortic valve and left ventricular outflow tract

Cardiology in the Young ◽

10.1017/s1047951105000995 ◽

2005 ◽

Vol 15 (S1) ◽

pp. 27-36 ◽

Cited By ~ 6

Author(s):

Alfred Asante-Korang ◽

Robert H. Anderson

Keyword(s):

Aortic Valve ◽

Left Ventricle ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Left Heart ◽

Transesophageal Echocardiogram ◽

Left Ventricular Outflow ◽

Echocardiographic Assessment

The previous reviews in this section of our Supplement1,2 have summarized the anatomic components of the ventriculo-arterial junctions, and then assessed the echocardiographic approach to the ventriculo-arterial junction or junctions as seen in the morphologically right ventricle. In this complementary review, we discuss the echocardiographic assessment of the comparable components found in the morphologically left ventricle, specifically the outflow tract and the arterial root. We will address the echocardiographic anatomy of the aortic valvar complex, and we will review the causes of congenital arterial valvar stenosis, using the aortic valve as our example. We will also review the various lesions that, in the outflow of the morphologically left ventricle, can produce subvalvar and supravalvar stenosis. We will then consider the salient features of the left ventricular outflow tract in patients with discordant ventriculo-arterial connections, and double outlet ventricles. To conclude the review, we will briefly address some rarer anomalies that involve the left ventricular outflow tract, showing how the transesophageal echocardiogram is used to assist the surgeon preparing for repair. The essence of the approach will be to consider the malformations as seen at valvar, subvalvar, or supravalvar levels,1 but we should not lose sight of the fact that aortic coarctation or interruption, hypoplasia of the left heart, and malformations of the mitral valve are all part of the spectrum of lesions associated with obstruction to the left ventricular outflow tract. These additional malformations, however, are beyond the scope of this review.

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Abstract W P250: The Impact of Acute Hypertensive Response on Mortality After Intracerebral Hemorrhage Differs Among Patients With and Without Left Ventricle Hypertrophy

Stroke ◽

10.1161/str.45.suppl_1.wp250 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Octavio M Pontes-Neto ◽

Sergi Martinez-Ramirez ◽

Anand Viswanathan ◽

Timothy C Tan ◽

Maria C Nunes ◽

...

Keyword(s):

Blood Pressure ◽

Left Ventricle ◽

Acute Phase ◽

Blood Pressure Reduction ◽

Chronic Hypertension ◽

Pressure Reduction ◽

Left Ventricle Hypertrophy ◽

Ventricle Hypertrophy ◽

Haenszel Test ◽

Intensive Blood Pressure

Background: While acute hypertensive response (AHR) predicts worse outcome in intracerebral hemorrhage (ICH), the INTERACT-2 trial recently failed to definitively demonstrate a major benefit of intensive blood pressure reduction on these patients. A possible explanation is that the detrimental effect of AHR on outcome may differ among ICH patients with and without previous chronic hypertension. Objective: to explore whether the prognosis of patients with AHR during the acute phase of ICH differs according to the presence or absence of left ventricle hypertrophy (LVH), which is a marker of chronic hypertensive organ damage. Method: we performed a retrospective analysis of a prospective cohort of patients with primary ICH presenting to an academic hospital between January/2000 and December/2012 with age > 18 years, who had a transthoracic echocardiogram available. LVH was defined according to Penn convention. AHR was defined as systolic blood pressure > 180 mmHg on admission. Mantel-Haenszel test was initially used to assess if LVH status influenced the effect of AHR on mortality. For subsequent analyses, ICH patients were divided in 3 groups: without AHR (reference); AHR without LVH; AHR with LVH. A multivariate logistic regression model was then used to identify independent predictors of mortality at 30-days. Results: 430 patients met inclusion criteria. AHR was present in 196 (46.6%), LVH was present in 233 (54.2%); 30-day mortality was 15.6%. On Mantel-Haenszel test, we found a trend (p=0.09) suggesting that absence of LVH increased AHR effect on mortality (OR:1.64; 95% CI: 0.95-2.8; p=0.07). On multivariate analysis, patients with AHR without LVH had significantly higher mortality (OR: 2.65; 95%CI: 1.15 to 6.1; p=0.022) when compared to patients without AHR, after adjusting for baseline characteristics. There was only a trend towards increased mortality in the group of patients with AHR and LVH (OR:2.22; 95% CI: 0.99-5.0; p=0.053). Conclusions: Patients without chronic hypertension appear to be more susceptible to the detrimental effects of AHR during the acute phase of ICH. Stratification of patients with ICH may help to identify those that will have greater benefit with intensive blood pressure reduction in the acute phase of ICH.

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