Mavacamten for Left Ventricular Outflow Tract Obstruction After Successful Transcatheter Aortic Valve Implantation

Figures

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  Figure 1. Invasive and Echocardiographic Hemodynamic Assessment Before and After TAVI Before transcatheter aortic valve implantation (TAVI), the systolic anterior motion of the mitral leaflet (SAM, arrow) was not prominent and left ventricular outflow tract (LVOT) flow velocity was not significantly high. Immediately after TAVI, no pressure gradient was present between the left ventricle (LV) and aorta (Ao), but follow-up echocardiography done several days after TAVI showed septal contact of SAM (arrow) resulting in a markedly increased pressure gradient across the LVOT. LA = atrium; Vmax = maximal velocity.

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  Figure 2. Chest X-Ray Serial chest x-ray showed late development of pulmonary congestion and bilateral pleural effusion despite medical treatment. The addition of mavacamten led to a significant normalization of heart size and the disappearance of bilateral pleural effusion. Abbreviation as in Figure 1.

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  Figure 3. Serial Echocardiographic Images of SAM Before TAVI, SAM was absent (A, white arrow), and immediately after successful TAVI, prominent SAM appeared (B, white arrow), which showed progressive septal contact (C and D, white and red arrows). Mavacamten treatment resulted in less septal contact of SAM (E, red arrow). Abbreviations as in Figure 1.

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  Figure 4. Serial Changes in MR Severity and LVOT Flow Before TAVI, mitral regurgitation (MR) was mild and LVOT velocity was low (A, red arrow). Twelve months after TAVI, severe MR and markedly elevated LVOT velocity were observed (B), which were alleviated with short-term treatment with mavacamten (C). Abbreviations as in Figure 1.

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  Figure 5. Serial Changes in Doppler Tracing of Mitral Inflow and Tricuspid Regurgitation Jet Before TAVI, an abnormal relaxation pattern of the mitral inflow with mild resting pulmonary hypertension was observed. During follow-up, a restrictive pattern of mitral inflow velocity with significantly elevated pulmonary hypertension was noted, which was reversed with mavacamten treatment. TR = tricuspid regurgitation.