Mid-ventricular Obstructive Hypertrophic Cardiomyopathy Research Articles

Mid-ventricular Obstructive Cardiomyopathy after Takotsubo Cardiomyopathy: A Case Report.

A 93-year-old woman was transferred to our hospital for lightheadedness. She had had Takotsubo cardiomyopathy for seven years. Transthoracic apical four-chamber echocardiography showed a large apical aneurysm. Pulsed-wave Doppler echocardiography at the left ventricular (LV) basal obstruction showed flow directed from the apex to the base during systole and isovolumic relaxation time. The patient was therefore diagnosed with mid-ventricular obstructive cardiomyopathy with a large apical aneurysm and paradoxical flow. The present case suggests that Takotsubo cardiomyopathy may become mid-ventricular obstructive hypertrophic cardiomyopathy without change in its structure.

A Experience of Surgical Treatment for Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy with Apical Ventricular Aneurysm

A Experience of Surgical Treatment for Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy with Apical Ventricular Aneurysm

Diastolic Paradoxic Jet Flow of the Right Ventricle in Hypertrophic Cardiomyopathy

An early diastolic flow from the left ventricular apex to the base can be shown in patients with hypertrophic cardiomyopathy (HCM). This tiny flow or a diastolic paradoxic jet flow is important to detect on echocardiography because of its association with cardiovascular adverse events. We report an asymptomatic 44-year-old man with mid-ventricular obstructive HCM, in which a diastolic paradoxic jet flow was observed not only in the left ventricle but also in the right ventricle. The diastolic paradoxic jet flow in the right ventricle started approximately 110 ms after the onset of the second heart sound, lasted for almost 95 ms, and disappeared in coincidence with the third heart sound; the onset was later and the duration was similar, compared with the diastolic paradoxic jet flow in the left ventricle. He had been doing well without any medication for months and later lost to follow-up. J Med Cases. 2020;11(3):57-60 doi: https://doi.org/10.14740/jmc3210

P52714D-flow cardiac magnetic resonance analysis of left ventricular blood flow dynamics in mid-ventricular obstructive hypertrophic cardiomyopathy

Abstract Background Mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM) has different blood flow dynamics from other phenotypes, but there are few detailed data on blood flow dynamics in the left ventricle. Methods 4D-Flow MRI were performed at 1.5 T or 3 T with 9 MVO-HCM patients and 22 control patients (LVEF>50%, no wall motion abnormality). Myocardial infarction, severe valvular disease, HCM cases other than MVO were excluded. We calculated the cardiac function parameters and observed blood flow dynamics in the left ventricle using 4D-Flow MRI. Results LV mass was significantly higher in MVO-HCM group than in Control group (Control group; 73.3g vs MVO-HCM group; 109.5g, P=0.019). LVEF was higher in MVO-HCM group (Control group; 61.6% vs MVO-HCM group; 70.6%, P=0.026), but Stroke volume did not differ between the two groups (Control group; 68.8ml vs MVO-HCM group; 64.4ml, P=0.43).One or two vortices were observed in the left ventricle after opening the mitral valve. Two vortices were observed in 16 cases (72.7%) in the control group and 9 cases (100%) in the MVO-HCM group. Two vortices were formed on the anterior side and the posterior side. Blood flow pattern in which the vortex on the posterior side was formed to be the same size or larger than the vortex on the anterior side was observed only in the MVO-HCM group (Control group; 0% vs MVO-HCM group; 66.7%, P<0.001). Streamline of MVO-HCM & Control Conclusion Characteristic blood flow patterns in the left ventricle of the MVO-HCM were revealed by using 4D-MRI. We thought that blood flow collides with the left ventricle wall due to the marked hypertrophy in the mid-ventricle, and normal vortex ring can not be formed in the MVO-HCM cases.

Ventricular tachycardia and heart failure in a patient of mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: A case report.

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHC) with apical aneurysm is a rare type of cardiomyopathy. It is associated with an elevated risk of ventricular arrhythmias, thromboembolism, heart failure and sudden cardiac death. The present case study reports on a patient with MVOHC and apical aneurysm who developed ventricular arrhythmias and heart failure. The patient received an implantable cardioverter defibrillator for prevention of fatal arrhythmias. Ventricular tachycardia was terminated by increased doses of amiodarone and β-blocker. Transthoracic echocardiography indicated a mid-ventricular gradient of 64 mmHg. The patient refused surgical treatment and opted for alcohol septal ablation (ASA). At the 6-month follow-up, a rebound of the gradient following ASA was observed on echocardiography. In the present study, timely recognition of MVOHC with apical aneurysm led to prompt defibrillator implantation for prophylaxis regarding further malignant arrhythmias. Surgical management should be considered in symptomatic patients with MVOHC and apical aneurysm.

Mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: An important subtype of arrhythmogenic cardiomyopathy.

Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is an uncommon type of HCM. LV apical aneurysms are present in more than 20% MVOHCM cases and has been identified as an independent predictor of potentially lethal arrhythmic events, including non-sustained or sustained ventricular tachycardia (VT), and ventricular fibrillation (VF), as well as SCD. Although the pathogenesis of LVA remains unknown, but it has been suggested that apical aneurysm may be secondary to the increased after-load and high apical pressure arising from significant pressure gradient of the midventricular obstruction. The scarred rim of the aneurysm and the adjacent areas of LV myocardial fibrosis and consequent apical oxygen-demand mismatch may be responsible for the formation of apical aneurysm. Recent electrophysiologic studies have demonstrated that the aneurysmal rim forms the primary culprit arrhythmogenic substrate for generation of monomorphic ventricular tachycardia leading to SCD, but the clinical significance of the size of aneurysm in relation to SCD remains unsettled. We summarized the clinical features of the patients with MVOHCM and apical aneurysms. Appropriate therapeutic interventions include ICD implantation, and early surgical intervention for gradient relief may be undertaken to relief the MVO.

A case report of sustained ventricular tachycardia in mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm

A case report of sustained ventricular tachycardia in mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm

A case report of mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm

A case report of mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm

Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm in Costello Syndrome: A Case Report

Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm in Costello Syndrome: A Case Report

Gözden Kaçırma Ölümcül Olabilir; Apikal Anevrizma ile İlişkili Ventrikül Ortası Darlığı Olan Hipertrofik Kardiyomiyopati

Mid-ventricular obstructive hypertrophic cardiomyopathy(MVOHCM) is a rare type of cardiomyopathy that can be accompanied by apical aneurysm. MVOHCM was demonstrated to have caused cardiac arrhytmias and sudden cardiac death. The identification of high-risk patients with hypertrophic cardiomyopathy (HCM) for primary prevention of sudden cardiac death (SCD) remains a challenging issue, since major risk factors sometimes lack specificity. We report the case of a patient who presented with ventricular fibrillation, ST-segment elevation on electrocardiography, and cardiac-enzyme elevation, in the presence of normal coronary arteries. Continuouswave Doppler echocardiography revealed a pressure gradient between the apical and basal chambers of the left ventricle.

A case of refractory ventricular tachycardia associated with coronary spastic angina and mid-ventricular obstructive hypertrophic cardiomyopathy

A case of refractory ventricular tachycardia associated with coronary spastic angina and mid-ventricular obstructive hypertrophic cardiomyopathy

Clinical characteristics and prognosis of 60 patients with midventricular obstructive hypertrophic cardiomyopathy.

Midventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare form of hypertrophic cardiomyopathy. Knowledge regarding the diagnosis, morbidity and cardiovascular mortality is limited. In this study, we aimed to describe the long-term outcomes of patients with MVOHCM followed in a tertiary referral centre.Methods A retrospective study of 60 patients with MVOHCM diagnosed at FuWai Hospital was performed. Clinical features, mortality and cardiovascular morbidity were analysed. The 60 patients with MVOHCM represented 2.9% of all the hypertrophic cardiomyopathy cases (n = 2068). At diagnosis, the mean age was 40.2 ± 15.0 years. During 7.1 ± 6.3 years of follow-up after diagnosis, the cardiovascular mortality was 15.0%. The probability of survival at 10 years was 77.0 ± 8.0%. The following two predictors of cardiovascular mortality were identified: severe ventricular septal hypertrophy at least 30 mm (hazard ratio, 3.19; P = 0.031) and unexplained syncope (hazard ratio, 4.59; P = 0.002) at baseline. Thirty patients (50.0%) had one or more morbid events, and the most frequent was nonsustained ventricular tachycardia. Apical aneurysm formation was identified in 20% of patients, and the patients with apical aneurysms were more inclined to experience nonsustained ventricular tachycardia than patients without apical aneurysm (58.3 vs. 16.7%; P = 0.003). Peak pressure gradient at least 70 mm Hg (hazard ratio, 3.00; P = 0.01) at baseline was identified as the only predictor of apical aneurysm. In Chinese patients, MVOHCM is associated with an unfavourable prognosis of cardiovascular mortality. One-half of these patients experience major cardiovascular events, and 20% develop an apical aneurysm, which significantly increases arrhythmia events. These data warrant measures to ensure the early recognition of MVOHCM followed by appropriate therapeutic interventions.

Ventricular tachycardia associated with mid-ventricular obstructive hypertrophic cardiomyopathy and apical aneurysm

Ventricular tachycardia associated with mid-ventricular obstructive hypertrophic cardiomyopathy and apical aneurysm

Mid-systolic flow reversal in a patient with mid-ventricular obstructive hypertrophic cardiomyopathy.

An 80-year-old man with palpitations presented to our hospital. A 12-lead electrocardiogram showed atrial fibrillation, complete right bundle branch block (CRBBB), right axis deviation, and negative T waves in leads II, III, aVF, and V1–V4. A chest radiograph showed a cardiothoracic ratio of 58 %. A 2D transthoracic echocardiography showed LV hypertrophy (the interventricular septum was 14 mm thick and the LV posterior wall was 9 mm thick), mid-ventricular obstruction, and apical aneurysm. A pulsed Doppler echocardiogram showed systolic mid-ventricular obstruction and paradoxical jet flow typical for MVOCM [2]. Moreover, additional mid-systolic flow reversal was intermittently observed at the obstruction. This flow was observed between the systolic flow and paradoxical jet flow (Figs. 1, 2a). The patient underwent cardiac catheterization to enable visualization of the mechanism of this flow reversal and to examine whether the apical aneurysm was caused by myocardial infarction. Simultaneous LV pressure recordings showed that the basal pressure intermittently surpassed the apical pressure in mid-systole, which corroborated the echocardiographic data (Fig. 2b). Coronary arteriography yielded normal results. The patient was discharged with beta-blocker, calcium channel blocker, and anticoagulation.

A case of mid-ventricular obstructive hypertrophic cardiomyopathy complicated with repetitive ventricular tachycardia

A case of mid-ventricular obstructive hypertrophic cardiomyopathy complicated with repetitive ventricular tachycardia

Intra-cardiac thrombus resolution after anti-coagulation therapy with dabigatran in a patient with mid-ventricular obstructive hypertrophic cardiomyopathy: a case report

IntroductionAlthough dabigatran, a novel oral anti-coagulant, has been approved for the prevention of thromboembolism in patients with non-valvular atrial fibrillation, the efficacy of dabigatran for the resolution of established intra-cardiac thrombi has not been validated. Herein is describe a case in which dabigatran was effective for thrombus resolution in a patient with a left ventricular aneurysm.Case presentationA 59-year-old Japanese man with a mid-ventricular obstructive hypertrophic cardiomyopathy-associated apical aneurysm presented with a left ventricular apical thrombus (15.0mm×17.0mm). Anti-coagulation therapy with dabigatran (150mg b.i.d. with meals) was initiated. Following dabigatran administration, weekly echocardiographic examinations demonstrated gradual decreases in thrombus size. After three weeks, no thrombus was detected and no systemic thromboembolic events had occurred.ConclusionsThe left ventricular apical thrombus resolved after dabigatran administration. Hence, dabigatran may represent an alternative to warfarin as a therapeutic option in patients with previously detected intra-cardiac thrombus.

Magnetic resonance imaging of mid-ventricular obstructive hypertrophic cardiomyopathy

A 66-year-old woman consulted our hospital for class II dyspnea according to the New York Heart Association functional classification system. She had a height of 156 cm and weight of 55 kg (after an increase of 2 kg within the past month). Her body temperature was 36.1°C, respiration rate 18 breaths/min, …

Simultaneous Pressure Recording in Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy

A 70-year-old man was diagnosed with mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) with apical aneurysm and paradoxic jet flow. At cardiac catheterization, pressure study showed that there was a markedly high pressure-gradient of 90 mmHg between the apex and the base in systole. Apical pressure was 350 mmHg after premature ventricular contraction. The apical aneurysm was already dilated and spherical in late systole; the absence of active relaxation was considered to be the cause of the paradoxic jet flow. In this report, we suggest the pathogenesis of left ventricular apical aneurysm and paradoxic jet flow in MVOHCM.

Midventricular Obstructive Hypertrophic Cardiomyopathy during Pregnancy Complicated by Pulmonary Embolism: A Case Report

Hypertrophic cardiomyopathy (HCM) with midventricular obstruction (MVO) is a rare condition occurring in 1% of HCM patients. It is characterized by asymmetric left ventricular hypertrophy with MVO and elevated intraventricular pressure gradients. Pulmonary embolism has been associated with mid-ventricular obstructive HCM. Briefly, this case presents an unusual clinical scenario where a young pregnant woman suffering from hypertrophic obstructive cardiomyopathy presents with dyspnea hemodynamic compromise related to pulmonary embolism illustrating hemodynamic challenges created by pregnancy and surgery. We concluded that simple measures such as communication between the cardiology and obstetric teams, understanding of the hemodynamic changes, anesthetic planning, and monitoring were paramount for the success in our patient.

Mid-ventricular Obstructive Hypertrophic Cardiomyopathy during Pregnancy Complicated by Preeclampsia and Acute Myocardial Infarction: A Case Report

Hypertrophic cardiomyopathy (HCM) with mid-ventricular obstruction (MVO) is a rare condition occurring in 1% of HCM patients. It is characterized by asymmetric left ventricular hypertrophy with MVO and elevated intraventricular pressure gradients. Myocardial infarction has been associated with mid-ventricular obstructive HCM. Briefly, this case presents an unusual clinical scenario where a young pregnant woman complicated by preeclampsia presents with myocardial injury and hemodynamic compromise related to undiagnosed HCM with MVO illustrating hemodynamic challenges created by pregnancy and surgery.