Surgical treatment of congenital aortic valve constriction with associated obstructive cardiomyopathy. Perioperative left intraventricular gradient treated with beta blockers. Apropos of a case
Latour, F.; Garabedian, V.; Barrière, J.C.; Marchand, M.; Castellani, L.; Brochier, M.
Archives des Maladies du Coeur et des Vaisseaux 76(2): 227-232
1983
ISSN/ISBN: 0003-9683 PMID: 6134502 Document Number: 204352
The authors report a case of congenital valvular aortic stenosis associated with echocardiographic and angiographic appearances of hypertrophic obstructive cardiomyopathy. After valvular replacement and partial myotomy a high intraventricular pressure gradient (125 mmHg) with low intra aortic pressure was recorded. High dose intravenous propranolol (25 mg in 2 hours) reduced this gradient to 50 mmHg allowing cardiopulmonary bypass to be discontinued. This clinical combination is associated with a risk of aggravation of the intra-ventricular obstructive phenomenon when the obstacle to left ventricular ejection is relieved: surgical myotomy was performed in similar, previously published cases. High doses betablocker therapy can be performed in similar, previously published cases. High dose betablocker therapy can be useful in this association and it may also be instituted when right intraventricular pressure gradient increase after relief of pulmonary valvular stenosis.