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.