Transcatheter transfemoral aortic valve replacement in a patient with acromegaly and severe left ventricular myocardial hypertrophy. Case report

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Abstract

Main causes of secondary hypertrophic cardiomyopathy include acromegalic cardiomyopathy. Heart damage in patients with the acromegaly is mediated both by the direct action of growth hormone and insulin-like growth factor-1, and increased deposition of collagen and lymphomononuclear cells in the myocardium, which leads to architectural changes, disturbances in fluid and electrolyte balance, severe left ventricular myocardial hypertrophy, diastolic and systolic left ventricular dysfunction and chronic heart failure. This article presents the world's first described observation demonstrating the possibility of successful transfemoral aortic valve repair to a comorbid patient with severe aortic stenosis according to the potential risks caused by the active form of the acromegaly.

About the authors

Nadezhda S. Maslennikova

Chazov National Medical Research Center of Cardiology

Author for correspondence.
Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-8232-1750

канд. мед. наук, врач-кардиолог 4 кардиологического отд-ния Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Olga S. Bulkina

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0003-4773-6966

канд. мед. наук, ст. науч. сотр. отд. ангиологии Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Alexander S. Kolegaev

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-5054-1310

канд. мед. наук, ст. науч. сотр. отд. сердечно-сосудистой хирургии, сердечно-сосудистый хирург Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Maxim I. Makeev

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-4779-5088

врач отд. ультразвуковых методов исследования Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Dmitry V. Ustyuzhanin

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-0402-3977

канд. мед. наук, ст. науч. сотр., отд. томографии

Russian Federation, Moscow

Svetlana N. Nasonova

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-0920-7417

канд. мед. наук, ст. науч. сотр. отд. заболеваний миокарда и сердечной недостаточности Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Alexey E. Komlev

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0001-6908-7472

врач-кардиолог отд. сердечно-сосудистой хирургии Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Ekaterina V. Kozlova

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-6847-4080

канд. мед. наук, мл. науч. сотр. отд. ангиологии Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Veronika V. Lopukhova

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-7667-9043

канд. мед. наук, ст. науч. сотр. отд. ангиологии Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Maria V. Petukhova

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com

клин. ординатор отд. ангиологии Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Vyatcheslav S. Pronin

Russian Medical Academy of Continuous Professional Education

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0003-0452-9465

д-р мед. наук, проф. каф. эндокринологии

Russian Federation, Moscow

Timur Е. Imaev

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0002-5736-5698

д-р мед. наук, рук. лаб. гибридных методов лечения сердечно-сосудистых заболеваний отд. сердечно-сосудистой хирургии, сердечно-сосудистый хирург Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

Yuri А. Karpov

Chazov National Medical Research Center of Cardiology

Email: nsmaslenn@gmail.com
ORCID iD: 0000-0003-1480-0458

д-р мед. наук, проф., гл. науч. сотр., рук. отд. ангиологии Научно-исследовательского института клинической кардиологии им. А.Л. Мясникова

Russian Federation, Moscow

References

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Supplementary files

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2. Fig. 1. Schematic representation of the main cardiovascular diseases occurring in patients with acromegaly and their key development mechanisms. Adapted from [5].

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3. Fig. 2. Changes in the patient's appearance before the verification of acromegaly, the photo is published with the patient's consent.

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4. Fig. 3. ECG of patient L. in 2017. Recording speed – 50 mm/s, voltage – 10 mm/mV. Sinus rhythm with heart rate of 53 beats per minute, 1st degree AV block, QRS duration 120 ms.

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5. Fig. 4. ECG of patient L. in 2022. Recording speed – 25 mm/s, voltage – 5 mm/mV. Sinus bradycardia with heart rate of 50 per minute, 1st degree AV block, CLBBB, QRS duration 120 ms, ECG signs of LVH in CLBBB (Kafka, Baranowski criteria).

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6. Fig. 5. Echocardiography. On the left: the apical four-chamber with pronounced hypertrophy of the LV myocardium. On the right: the apical three-chamber with AV calcification.

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7. Fig. 6. Transthoracic echocardiography. On the left: the half-life of the diastolic gradient on the AV; on the right: the indicators of aortic valve stenosis.

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8. Fig. 7. ECG, Feb. 2023.

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9. Fig. 8. Contrast-enhanced cardiac MRI, arrows indicate areas of intramyocardial fibrosis.

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10. Fig. 9. SAM-criterion, aorto-mitral angle <130° (estimated value 94°).

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11. Fig. 10. Chest X-ray. On the left: before the surgery; on the right: a week after the surgery. A decrease in the size of the heart and no pulmonary hemodynamics disorders were observed.

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