PP-063 A Rare Cause of Left Ventricular Outflow Tract Obstruction: Elongated Mitral Chordae Tendineae

Abstract

Fifty six years old asymptomatic, hypertensive male patient referred to our clinic for evaluation of cardiac murmur. Auscultation revealed a grade 3/6 systolic ejection murmur at right second intercostal space. 12 lead ECG showed sinus rhythm and voltage criteria for left ventricular (LV) hypertrophy (Cornell criteria). Transthoracic echocardiography revealed left ventricular concentric hypertrophy. Septal wall diastolic thickness was 14mm. Sixteen mmHg resting pressure gradient was measured at LVOT (Figure 1A). Gradient at LVOT augmented to 64mmHg with Valsalva maneuver (Figure 1B). But there was no SAM. Patient underwent transesophageal echocardiography (TEE) for detailed examination of pathology that cause LVOT obstruction. Transesophageal echocardiography clearly demonstrated systolic anterior prolapse of the elongated, floating-like chordae tendinea through the aortic valve (Figure 1C, Arrow). Color Doppler echocardiography showed narrowing of LVOT secondary to elongated chordae and resultant systolic turbulence (Figure 1D). Other cardiac structures were normal. We managed the patient medically and prescribed beta blocker.