Clavellina RJM

Language: Spanish
References: 21
Page: 62-67
PDF size: 266.00 Kb.

ABSTRACT

The hypertrophic obstructive cardiomyopathy is a disease characterized by many morphological, physiopatological and clinical changes. The majority of patients are asymptomatic for several years, some of them had several and progressive symptoms and sudden death. The diastolic dysfunction, myocardial ischemia, arrhythmias and outlet obstruction of the left ventricle are the most important components which determine the clinic course. The objective of the study was to confirm that permanent dual-chamber pacemakers decrease the subaortic gradient by pacemaker stimulation auricle-ventricular. Material and methods: Six patients were selected who had dizziness, syncope an cardiac failure class III. On physical examination a mesosystolic aortic murmur was present, the echo-Doppler findings a left ventricular outflow tract gradient which was confirmed by cardiac catheterism. A pacemaker was introduced into these patients and the stimulation auricle-ventricular was made from 140 mseg. Results: The auricle-ventricular stimulation produced a decrease in the subaortic gradient with stimulation of 90 mseg and the anterior movement systolic of the mitral valve and the regurgitation disappeared. Conclusion: The subaortic gradient decrease with the auricle-ventricular stimulation, the dual-chamber pacemaker can be an alternative for treatment.

REFERENCES

1. Maron BJ, Bonow RO, Cannon RO, Leon MB, Epstein SE. Hypertrophic cardiomyopathy of clinical manifestations, pathopysiology, and therapy. N Engl J Med 1987; 316: 780-789.

2. Jarcho JA. McKenna W, Pare PJA. Solomon SD, Geisterfer-Lawrence A, Holcombe RF. Mapping a gene for familial hypertrophic cardiomyopathy to chromosome 14ql. N Eng J Med 1989; 32: 1372-1378.

3. Watkins H, Rosenzweig A, Hwang DS, Levi T, McKenna W, Seidman CE, Seidman JG. Characteristics and prognostic implications of myosin missense mutations in familial hypertrophic cardiomyopathy. N Engl J Med 1992; 326: 1108-1114.

4. Hejtmancik JF, Brink PA, Towbin J, Hill R, Brink L, Tapscott T. Localization of gene for hypertrophic cardiomyopathy to chromosome 14ql in diverse US population. Circulation 1991; 83: 1592-1597.

5. Epstein ND, Cohn GM, Cyran F, Fananapazir L. Differences in clinical expression of hypertrophic cardiomyopathy associated with two distinct mutations in B-myosin heavy chain gene. Circulation 1992; 86: 345-352.

6. Fananpazir L, Epstein ND. Genotype-phenotype correlations in hypertrophic cardiomyopathy, insights provided by comparisons of kindred with distinct and identical B-myosin heavy chain gene mutations. Circulation 1994; 89: 22-32.

7. Thierfelder L, Mac. Rae C, Watkins H, McKenna W, Vosberg HP. Familial hypertrophic cardiomyopathy is a disease of the sarcomere. Circulation 1994; 90 (suppl 1): I-519 Abstract.

8. Watkins H, McKenna WJ, Thierfelder L, Suk HJ, Anan R. mutations in the genes for cardiac troponina T and alfa-tropomyosin in hypertrophic cardiomyopathy. N Engl J Med 1995; 332: 1058-1064.

9. Mac Rae C, Ghaisas N, Mc Garry K, McKenna W, Seidman JG. Familial hypertrophic cardiomyopathy with Wolff-Parkinson-White syndrome maps to locus on chromosome 7q3 (Abstract). Circulation 1994; 90 (suppl 1): I-25.

10. Rakowski H, Williams WG. Hypertrophic cardiomyopathy, the importance of the site and extent of hypertrophy: A review. Prog Cardiovasc Dis 1985: 1-83.

11. Pollick C, Morgan CD, Gilbert BW, Rakowski H, Wigle ED. Muscular subaortic stenosis: the temporal relationship between systolic anterior motion of the anterior mitral leaflet and pressure gradient. Circulation 1982; 66: 1087-1093.

12. Pollick C, Rakowski H, Wigle ED. Muscular subaortic stenosis the quantitave relationship between systolic anterior motion and pressure gradient. Circulation. 1984; 69: 43-49.

13. Wigle ED, Rakowski H, Kimball BP, Williams WG. Hypertrophic cardiomyopathy. Clinical spectrum and treatment. Circulation 1995; 92: 1680-1682.

14. Spirito P, Seidman CE, McKenna WJ, Maron BJ. The management of hypertrophic cardiomyopathy. N Eng1 J Med 1997: 775-785.

15. Knight C, Kurbaan AS, Seggewiss a Henein M, Gunning M, Harrington D et al. Nonsurgical septal reduction for hypertrophic obstructive cardiomyopathy. Outcome in the first series of patients. Circulation 1997; 95: 2075-2081.

16. Braunwald E. Induced septal infarction. A new therapeutic strategy for hypertrophic obstructive cardiomyopathy. Circulation 1997; 95: 1981-1982.

17. Fananpazir L, Epstein ND, Curiel RV, Panza JA, Tripodi, McAreavey D. Long-term results of dual-chamber (DDD) pacing in obstructive hypertrophic cardiomyopathy. Evidence for progressive symptomatic and haemodynamic improvement and reduction of left ventricular hypertrophy. Circulation 1994; 90: 2731-2742.

18. Maron BJ, Nishimura RA, MacKenna WJ, Rakowski, Josephson ME, Kieval RS. Assesment of pennantment dual-chamber pacing as a treatment for drug-refractory symptomatic patients with obstructive hypertrophic cardiomyopathy. A randomized double blind, crossover study (M-PATHY). Circulation 1999; 99: 2927-2933.

19. Nishimura RA, Trusty JM, Hayes DL, Ilstrup DM, Larson DR, Hayes SN et al. Dual-chamber pacing for hypertrophic cardiomyopathy. A randomized, double-blind cross-over study. J Am Coll Cardiol 1997; 29: 435-441.

20. Koffland MJ, Waldstein DJ, Vos Ten Cate. Prognosis in hypertrophic cardiomyopathy observed in a large clinic population. Am J Cardiol 1993; 72: 939-943.

21. McKenna WJ, Camm AJ. Sudden death in hypertrophic cardiomyopathy assessment of patients at high risk. Circulation 1989; 80: 1489-1492.