Crypt of the left ventricular apex.

Abstract

A 61-year-old Japanese woman was introduced our hospital because of abnormality in electrocardiography (ECG). She had no symptom, and no past and family history. Three years ago, ECG showed sinus rhythm, negative T waves in I, aVL, V2 to V6 leads, and no left ventricular hypertrophy (Panel A). Echocardiography showed normokinesis (ejection fraction, 64%). Contrast enhanced computed tomography (CECT) showed normal coronary arteries but crypts (arrows) at left ventricular apex with mild hypertrophy (Panel B, C). At this time, ECG showed new negative T waves in II and aVF in addition to progression of negative T waves in I, aVL, V2 to V6 leads (Panel D). CECT showed almost disappearing crypt (arrow) due to progression of apical hypertrophy (Panel E, F). Left ventricular crypts are congenital fissure-like protrusion penetrating more than 50% of the thickness of adjoining compacted myocardium. They are commonly seen in the basal inferior wall of left ventricle and interventricular septum in hypertrophic cardiomyopathy (HCM) and HCM carriers who have not yet hypertrophy. Apical crypt may be one of the markers of progression to apical HCM that is more seen in Japanese.