PP-217 Hypertrophic Cardiomyopaty with Mid-Ventricular Obstruction: One Obstruction, Three Dictinct Jet in One Chamber

Abstract

A 65-year-old male admitted to outpatient clinic with shortness of breath. He had no known cardiac disease. The electrocardiography showed left ventricular (LV) hypertrophy and strain pattern(A).Echocardiography demonstrated concentric hypertrophy of LV with an apical aneurysm and mid-ventricular obstruction(MVO).ColorDoppler displayed a turbulence of blood flow at midventricular(MV) level and pulsed wave Doppler mapping ofLV demonstrated systolic intra-ventricular gradient at MV.Continuouswave Doppler envelope consisted of3distinct high velocity jet peaks(B).There was nomitral regurgitation flow detected with colorM-mode(C).Myocardial perfusion imaging revealed focal reversible ischemia at LV apex.Obstructive coronary artery disease wasexcluded by coronary angiography as a cause of ischemia and apical aneurysm formation.However, ventriculography displayed typical hourglass appearance ofLVcavity with a delayed apical emptying(D).Also cardiac magnetic resonance imaging(MRI) showed late gadolinium enhancement of the scarred rim of the aneurysm(E).Toprotect the patient from sudden death because of arrhythmic events we implanted implantable cardiac device.