Abstract
Case reportA Chinese woman was admitted to our hospital because of syncope. Transthoracic echocardiography revealed a hypertrophic basal interventricular septum of 15 mm with a sharp angle protruding into the left ventricular outflow tract. Moreover, an anomalous anterolateral papillary muscle (maximum width of 11 mm) was inserted into the left ventricular outflow tract, with short chordae tendineae connecting both basal interventricular septum and anterior leaflet of the mitral valve. All of these abnormalities resulted in a left ventricular outflow gradient of 136 mmHg. Surgical septal myectomy of the sharp angle combined with partial papillary muscle resection and removal of the abnormal chordae tendineae was selected to relieve the left ventricular outflow obstruction. This was a rare combination of deformity of the angulation of the focal basal interventricular septum and abnormalities of the papillary muscle and chordae tendineae, which led to left ventricular outflow obstruction.
Highlights
A Chinese woman was admitted to our hospital because of syncope
Transthoracic echocardiography revealed a hypertrophic basal interventricular septum of 15 mm with a sharp angle protruding into the left ventricular outflow tract
Surgical septal myectomy of the sharp angle combined with partial papillary muscle resection and removal of the abnormal chordae tendineae was selected to relieve the left ventricular outflow obstruction
Summary
A 43-year-old Chinese woman was admitted to our hospital because of syncope. Physical examination showed a loud systolic ejection murmur radiating to the neck. Left ventriculography demonstrated a narrow LVOT with a sharp angle. Intraoperative transoesophageal echocardiography clearly showed the presence of a focal hypertrophic IVS and malposition of the PM (Fig. 1E). The sharp angle of the IVS and the abnormal PM were demonstrated clearly after the extended transaortic approach was used (Fig. 2A, B). The first step was septal myectomy of the sharp angle via the aortic valve. After recovery of the heart beat, transoesophageal echocardiography showed that the LVOT gradient was still about 100 mmHg because of the malposition of the PM and the short chordae tendineae (Fig. 2C). The saline injection test revealed trivial mitral and aortic valve regurgitation. At the two-month follow up, transthoracic echocardiography demonstrated a LVOT gradient of 23 mmHg and no significant mitral valve insufficiency (Fig. 3C). Institutional review board permission was obtained to report this case
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