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Posterior deviation of left ventricular outflow tract septal components without ventricular septal defect



Posterior deviation of left ventricular outflow tract septal components without ventricular septal defect



Heart 77(3): 242-246



Objective-To describe 11 patients with narrowing of the left ventricular outflow tract caused by angular posterior deviation of both the outlet septum and the upper part of trabecular septum, which was diagnosed by cross sectional echocardiography in all and confirmed by angiocardiography in seven. Result sbd Four patients had a subaortic systolic pressure gradient ranging from 23 to 70 mm Hg by Doppler echocardiograpy; cardiac catheterization showed a significant (60 and 104 mm Hg) systolic pressure gradient in two. In four cases aortic regurgitation and two tricuspid pouches were shown by Doppler echocardiography, angiocardiography, or both. Four cases had a ridge at the angulation point on echocardiographic examination. Three patients were operated on for systolic pressure gradients of the left ventricular outflow tract and one for severe aortic regurgitation. There was proliferation of collagen-rich fibrous tissue in the subendocardial region on histopathological examination of the myectomy material. A ventricular septal defect had been diagnosed previously by contrast echocardiography in one patient; thus ventricular septal defects may close spontaneously over a period of time including fetal life. A subaortic ridge was detected in one patient at follow up. Conclusions-Deviation of the outlet and trabecular septa should be considered as a cause of ventricular outflow tract obstruction even when no ventricular septal defect is present.

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Accession: 009218837

Download citation: RISBibTeXText

PMID: 9093042

DOI: 10.1136/hrt.77.3.242


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