Dynamic obstruction of left ventricular outflow tract due to bilateral pulmonary embolism

Abstract

A 68-year-old male patient with a history of nonobstructive hypertrophic cardiomyopathy was admitted to the cardiac intensive care unit due to sudden onset of near syncope and hypotension. The diagnosis of acute bilateral pulmonary embolism was confirmed by pulmonary computed tomographic angiography. On day 2 of admission, left ventricular outflow tract (LVOT) obstruction was demonstrated by increased peak systolic blood flow (454 cm/s) and increased transvalvular pressure gradient (83 mmHg), as well as systolic anterior motion of the mitral valve leaflet. LVOT obstruction underwent a gradual normalization and was completely resolved on day 21 after symptom onset, and the patient was discharged. Acute pulmonary embolism is a rare cause of LVOT obstruction. In this case, the concomitant existence of nonobstructive hypertrophic cardiomyopathy exacerbated LVOT obstruction due to right ventricle overload-induced leftward deviation of interventricular septum and may render the patients at higher risk for sudden death. More active anticoagulation therapy should be considered in this situation.

Keywords

• Dynamic obstruction
• left ventricular outflow tract obstruction
• nonobstructive hypertrophic cardiomyopathy
• pulmonary embolism