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added by Emmel

Posted By: ohtusabes (1996 days ago)

I think he need cath-lab but I don´t believe that it changes the LBBB
and asyncrony...so CRT maybe will help him a lot.

Posted By: Emmel (1997 days ago)

Hello Pablo;
Thanks a lot for comment!
The reason for
LV-Dysfunction is not clear; the patient denied a cardiac catheter;
arterial hypertension is known, but is that enough for explanation for
such a LV-dilatation?
dp/dt measurement in respect to mitral
regurgitation is about 500-600 mmHg/s, but I think that contractility
is more limited. You´re absolutely right I think that is a distinct
high grade mitral regurgitation, too.
I hope, that that patient
will agree to a cardiac catheter, because I don´think that is would
make sence to implantate a CRT-D or CRT-P without doing the necessary
invasive diagnostic.
Best wishes ,


Posted By: ohtusabes (1999 days ago)

Impressive clip...nice example of asyncronic LV contraction. What is
the cause of LV dilation? posterolateral papillary muscle looks
hypertrophied so excentric LV hypertrophy is a possibility... and
ischemic cardiomiopathy...cath lab?

LV function is more
depressed than it looks, simple because is bad in context of the low
afterload impossed by severe MR...

Dp/Dt was ?

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Added: 24-02-2013
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about 80 y old patient with prolonged dyspnoea. In TTE we could see a distinct lost of myocardial function with asynchrone myocardial wall motion (SPWMD about 150 ms, IVMD about 60 ms); high grade mitral insufficiency because of dialatation of mitral valve annulus (Carpentier I) and secondary pulmonary hypertension (PAPsystolic about 50-55 mmHg + CVP, RAP-approach on dilatated VCI without inspiratory collaps about 20 mmHg). actually there is no optimal medical therapy established. Some therapeutical options should be dicussed in future: CRT-D, mitral valve clipping.

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