{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:34:55Z","timestamp":1787243695511,"version":"build-2736575974"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atrioventricular septal defect (AVSD) is a congenital heart disease characterized by intracardiac shunting due to septal defects, often associated with left ventricular outflow tract obstruction (LVOTO) caused by myocardial anomalies. Surgical intervention is recommended for AVSD if needed. This case report presents a rare case of LVOTO developing in the extremely remote period after partial Atrioventricular septal defect (pAVSD) surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Summary<\/jats:title>\n                    <jats:p>A 35-year-old man with a history of intracardiac repair for pAVSD presented with worsening exertional dyspnoea. Transoesophageal echocardiography led to the diagnosis of LVOTO caused by systolic anterior motion (SAM) of an abnormal chordae without myocardial hypertrophy and mitral valve prolapse. Medical therapy was attempted but proved completely ineffective, so surgical resection of the abnormal chordae causing SAM was performed via open-heart surgery. Postoperatively, the LVOTO resolved, and the patient\u2019s symptoms disappeared.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>AVSD has anatomical characteristics that allow it to be associated with LVOTO in various forms; however, much remains unknown about the modes of onset and the progression of the condition. It is reported that most cases of LVOTO after intracardiac repair of AVSD occur within five years postoperatively; however, rare cases can present in the late postoperative period. Among these are cases in which symptoms become apparent due to rare anatomical features such as chordal SAM, or haemodynamic changes associated with lifestyle modifications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytaf539","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T11:33:32Z","timestamp":1761046412000},"source":"Crossref","is-referenced-by-count":1,"title":["Left ventricular outflow tract obstruction caused by abnormal mitral valve tendinous Chordae manifesting in the extremely remote period after surgery for partial atrioventricular septal defect: a case report"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2020-0792","authenticated-orcid":false,"given":"Takanori","family":"Kawamoto","sequence":"first","affiliation":[{"name":"Department of Cardiology, Tokyo Women\u2019s Medical University , Tokyo 162-8666 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8956-9698","authenticated-orcid":false,"given":"Tomohito","family":"Kogure","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Women\u2019s Medical University , Tokyo 162-8666 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0656-4053","authenticated-orcid":false,"given":"Takeshi","family":"Shinkawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Tokyo Women\u2019s Medical University , Tokyo 162-8666 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyomi","family":"Ashihara","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Women\u2019s Medical University , Tokyo 162-8666 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0967-0978","authenticated-orcid":false,"given":"Junichi","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Tokyo Women\u2019s Medical University , Tokyo 162-8666 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"2025111304273268800_ytaf539-B1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1053\/j.pcsu.2007.02.002","article-title":"Partial atrioventricular canal: pitfalls in technique","volume":"10","author":"Manning","year":"2007","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann"},{"key":"2025111304273268800_ytaf539-B2","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.athoracsur.2022.08.011","article-title":"Subaortic stenosis in adult patients with atrioventricular septal defect","volume":"115","author":"Perez","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"2025111304273268800_ytaf539-B3","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1093\/icvts\/ivab303","article-title":"Incidence and management of the left ventricular outflow obstruction in patients with atrioventricular septal defects","volume":"34","author":"Ivanov","year":"2022","journal-title":"Interactive Cardiovasc Thorac Surg"},{"key":"2025111304273268800_ytaf539-B4","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.athoracsur.2016.01.085","article-title":"Repair of partial atrioventricular septal defect: age and outcomes","volume":"102","author":"Devlin","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2025111304273268800_ytaf539-B5","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/j.athoracsur.2010.01.018","article-title":"Reoperations after repair of partial atrioventricular septal defect: a 45-year single-center experience","volume":"89","author":"Stulak","year":"2010","journal-title":"Ann Thorac Surg"},{"key":"2025111304273268800_ytaf539-B6","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1002\/clc.4960140611","article-title":"Left ventricular outflow tract obstruction in atrioventricular septal defects: a pathologic and morphometric evaluation","volume":"14","author":"Gallo","year":"1991","journal-title":"Clin Cardiol"},{"key":"2025111304273268800_ytaf539-B7","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S0022-5223(19)37284-8","article-title":"Left-sided obstructive lesions in atrioventricular septal defects: an anatomic study","volume":"83","author":"Piccoli","year":"1982","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025111304273268800_ytaf539-B8","first-page":"42","article-title":"Reoperation for left ventricular outflow tract obstruction after repair of atrioventricular septal","volume":"10","author":"Overman","year":"2007","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann"},{"key":"2025111304273268800_ytaf539-B9","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/S0002-8703(96)90282-3","article-title":"Systolic anterior motion of the mitral chordae tendineae: prevalence and clinical and Doppler-echocardiographic features","volume":"131","author":"Pearson","year":"1996","journal-title":"Am Heart J"},{"key":"2025111304273268800_ytaf539-B10","doi-asserted-by":"crossref","first-page":"3095","DOI":"10.1001\/jama.283.23.3095","article-title":"Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure; a randomized trial","volume":"283","author":"Hambrecht","year":"2000","journal-title":"JAMA"},{"key":"2025111304273268800_ytaf539-B11","doi-asserted-by":"crossref","first-page":"6632","DOI":"10.1038\/s41598-023-33873-x","article-title":"Intensity\u2013dependent cardiopulmonary response during and after strength training","volume":"13","author":"Lassing","year":"2023","journal-title":"Sci Rep"},{"key":"2025111304273268800_ytaf539-B12","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/S0735-1097(01)01464-4","article-title":"Discrete subaortic stenosis in adults: increased prevalence and slow rate of progression of the obstruction and aortic regurgitation","volume":"38","author":"Oliver","year":"2001","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytaf539\/64875754\/ytaf539.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/11\/ytaf539\/64875754\/ytaf539.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/9\/11\/ytaf539\/64875754\/ytaf539.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T09:27:41Z","timestamp":1763026061000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytaf539\/8299830"}},"subtitle":[],"editor":[{"given":"Flemming Javier","family":"Olsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Alejandro Ismael","family":"Cordero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Ivan","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":12,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,10,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytaf539","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,10,22]]},"article-number":"ytaf539"}}