Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy Elena A. Ashikhmina,

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Intraoperative direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy Elena A. Ashikhmina, MD, Hartzell V. Schaff, MD, Steve R. Ommen, MD, Joseph A. Dearani, MD, Rick A. Nishimura, MD, Martin D. Abel, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 1, Pages 53-59 (July 2011) DOI: 10.1016/j.jtcvs.2010.08.011 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Maximal instantaneous gradient versus peak-to-peak gradient. Maximal instantaneous gradient (Max ΔP) is calculated at the moment of maximal Ao (aortic) jet velocity (Vmax) through the valve. Peak-to-peak gradient (Peak-Peak ΔP) is calculated by subtraction of maximal left ventricular (LV) pressure from maximal Ao pressure. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 53-59DOI: (10.1016/j.jtcvs.2010.08.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Peak-to-peak left ventricular outflow tract gradient after provocation test with premature ventricular contraction. Pressures in the left ventricle (LV) and in the aorta (Ao) are recorded simultaneously. Peak-to-peak gradient is calculated by subtraction of Ao pressure from LV pressure in systole. Note gradient increase after premature ventricular contraction (PVC). The Journal of Thoracic and Cardiovascular Surgery 2011 142, 53-59DOI: (10.1016/j.jtcvs.2010.08.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Left ventricular and aortic pressures before and after isoproterenol provocation. Note the increase of peak-to-peak left ventricular (LV) outflow tract gradient after isoproterenol infusion and subsequent premature ventricular contraction (PVC), compared with baseline measurements. Ao, Aortic; IV, intravenous. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 53-59DOI: (10.1016/j.jtcvs.2010.08.011) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions