DYNAMIC LEFT-VENTRICULAR OUTFLOW TRACT OBSTRUCTION AFTER ANTERIOR MYOCARDIAL-INFARCTION - A POTENTIAL MECHANISM OF MYOCARDIAL RUPTURE

This study describes a dynamic left ventricular outflow tract gradient complicating an acute anterior myocardial infarction in two patients. In both cases, hyperdynamic contraction of the non-infarcted segments were noted in addition to large antero-apical a- or dyskinesia. Both patients had evidence of mitral annular calcifications, and the occurr ence of dynamic outflow tract obstruction preceded sudden death. Early recognition of the underlying pathophysiological mechanism might have major therapeutic implications and could decrease the risk of myocard ial rupture.