Comment
In this rare case, we demonstrated that systolic dysfunction in LVHT can be reversible after concomitant severe AR is surgically corrected. The absence of a cardiomyopathy and good compliance with optimal medical treatment might have contributed to the recovery of systolic function. Recovery of left ventricular systolic function in LVHT following heart failure treatment has been previously described, although in different clinical scenarios [1, 4, 5].
It remains uncertain whether systolic dysfunction in the presented patient was related to LVHT, aortic regurgitation or longstanding unregulated hypertension. Most likely, all these factors together may have played a role. The mechanism of severe AR in our patient was distension of the aortic annulus due to ectasia of the ascending aorta while there was no structural valvular abnormality of the aortic valve [3]. Wilbring et al, have reported a patient suffering LVHT cardiomyopathy in combination with low-gradient aortic stenosis who underwent aortic valve replacement [6]. The authors emphasized that bad prognosis is primarily affected by impaired ventricular function, thromboembolic complications, and arrhythmias [6].
However, whether LVHT in our patient was congenital or acquired remains unclear, as he had no previous imaging to compare with. Despite management of LVHT has been described in a few case reports, further larger studies are needed to demonstrate whether LVHT can regress or not [4, 5]. Eurlings et al. have reported that LVHT may be either reversible or may have a dynamic course [4].
Surgical trabeculectomy has been reported rarely in LVHT and it was mostly performed in patients with isolated LVHT [7-9]. We refrained from trabeculectomy due to several reasons. Our patient did not have history of thromboembolic complications or arrhythmias. To our knowledge, there were only a few reports on surgical trabeculectomy, but none of these cases included a patient with severe AR. There was no evidence in the presented case that the trabeculations impeded diastolic filling of the ventricle, as observed in two out of three reported cases [8, 9].
In conclusion, timely surgical correction of severe AR may also lead to improvement of systolic dysfunction along with concomitant LVHT.
Acknowledgments: none.
Author contributions: SB, JF: Conceptualization; Investigation; Methodology; Writing-original draft; Writing–Review&Editing. CS, VS, VP, KB, DS: Conceptualization; Investigation; Writing-Review&Editing.