Mitral Regurgitation In Hypertrophic Cardiomyopathy Research Articles

Transcatheter Treatment of Residual Systolic-Anterior Motion and Severe Mitral Regurgitation in Hypertrophic Cardiomyopathy

Transcatheter Treatment of Residual Systolic-Anterior Motion and Severe Mitral Regurgitation in Hypertrophic Cardiomyopathy

Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review.

Abnormalities of the mitral valve (MV) apparatus are typical features of hypertrophic cardiomyopathy (HCM). These abnormalities include leaflet elongation, thick leaflets, displacement of papillary muscle, and systolic anterior motion (SAM) of the MV anterior leaflet. Mitral valve chordal rupture associated with HCM is a rare but serious issue capable of change the clinical apparence and the prognosis of the patient. A 57-year-old lady with a history of diabetes, dyslipidemia, and a previous single episode of atrial fibrillation (treated with pharmacological cardioversion), presented to the Emergency Department for worsening dyspnea (New York Heart Association Classification class IV). A trans-thoracic echocardiogram (TTE) showed a significant, septal, and asymmetric left ventricular hypertrophy (basal anteroseptal wall diastolic thickness of 19 mm) with normal left ventricle systolic function. A SAM of AML was evident together with a left ventricular outflow tract gradient of 56 mmHg at rest, rising to 136 mmHg during the Valsalva maneuver. In addition, there was evidence of moderate to severe mitral regurgitation (MR) with an anteriorly directed jet, not very typical of MR related to SAM. A 2D-3D trans-esophageal echocardiogram (2D-3D TEE) revealed a combined MR mechanism based on PML degenerative prolapse with P2-flail from ruptured chordae with related eccentric anteriorly directed regurgitant jet, together with a second regurgitant posteriorly directed jet, related to SAM of AML. The patient underwent MV repair together with septal myectomy, with a good final outcome. Pre-operative echocardiography (both TTE and 2D-3D TEE) is an essential tool in order to detect different MV abnormalities in patients with HCM. These types of patients should never be treated by septal reduction alone. Surgical MV repair or replacement, together with septal myectomy, may be the preferred approach.

Mitral Regurgitation in Hypertrophic Cardiomyopathy: A Narrative Review of Mechanism and Current Management

Significant mitral regurgitation (MR) is frequent in patients with hypertrophic cardiomyopathy (HCM) either obstructive or non-obstructive. Many studies described that significant MR is associated with poor long-term outcome of HCM patients, which indicate the importance of an adequate MR assessment including detailed evaluation of the mitral valve (MV) anatomy. Mitral malformations have been identified in HCM at all levels.

A very rare cause of mitral regurgitation in hypertrophic cardiomyopathy: the quadricuspid mitral valve.

A very rare cause of mitral regurgitation in hypertrophic cardiomyopathy: the quadricuspid mitral valve.

Prognostic value of mitral regurgitation in patients with asymmetric hypertrophic cardiomyopathy

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Since mitral regurgitation (MR) is a very common finding in patients with hypertrophic cardiomyopathy (HCM), the evaluation of the mitral valve anatomy and the degree of MR is of utmost importance in this population. However, data regarding the prognostic value of different degrees of MR in HCM remains scarce. Purpose The aim of this study was to determine whether the presence of a higher degree of MR affects: 1) long term prognosis; 2) clinical and echocardiographic presentation of HCM patients. Material and Methods We included prospectively 102 patients, diagnosed with primary asymmetric HCM. The degree of MR was determined echocardiographicaly according to current recommendations of the American Association of Echocardiography. According to the MR severity, patients were divided into 2 groups: Group 1 (n = 52) with no/trace or mild MR and Group 2 with moderate or moderate to severe MR. All patients had clinical and echocardiographic examination, 24-hour Holter ECG and NT pro BNP analysis performed. The primary outcome was a composite of: 1) HCM related death or sudden death; 2) hospitalization due to acute heart failure; 3) sustained ventricular tachycardia; 4) ischemic stroke. Results Patients with higher MR degree had more frequent chest pain (p = 0.039), syncope (p = 0.041) and NYHA II functional class (p < 0.001). Group 2 patients had mostly obstructive form of HCM (p < 0.001) with more frequent presence of previous atrial fibrillation (AF) (p = 0.032), as well as the new onset of AF (p = 0.014) compared to patients in Group 1. Patients with higher MR degree had significantly more SAM (p < 0.001) resulting in a more frequent eccentric MR jet (p < 0.001), along with calcified mitral annulus (p = 0.007), enlarged left atrial volume index (p < 0.001), and elevated right ventricular pressure (p = 0.001). As a result of higher MR grade, Group 2 had higher E/e" values (p < 0.001), elevated LV filling pressure (lateral E/e’ >10), as well as higher levels of NT pro BNP (p = 0.001). By Kaplan-Meier analysis we demonstrated that the event free survival rate during follow up of median 75 (IQR 48-103) months was significantly higher in Group 1 compared to the Group 2 (79% vs. 46%, p < 0.001), Figure 1. After adjustment for relevant confounders, moderate/moderate to severe MR remained as an independent predictor of adverse outcome (hazard ratio 2.58, 95% CI: 1.08-6.13, p < 0.001). Conclusion Presence of moderate, or moderate to severe MR was associated with poor long-term outcome of HCM patients. These results indicate the importance of an adequate MR assessment and detailed evaluation of the mitral valve anatomy in the prediction of complications and adequate treatment of patients with HCM. Abstract Figure.

Pulsed Doppler Echocardiography: An Historical Perspective

Over the past six decades, echocardiography has evolved into an important technique for not only imaging cardiac structures, but also, by employing the Doppler equation, for assessing cardiac blood flow and tissue velocities. This review focuses on pulsed Doppler echocardiography: its principles, early development, and clinical applications. Important clinical applications include: (1) measurement of flow velocities, stroke volumes, and regurgitant and shunt volumes; (2) assessment of time intervals, e.g., pulmonary artery acceleration time as a measure of pulmonary artery pressure and resistance or the timing of mitral regurgitation in hypertrophic cardiomyopathy; (3) detection of turbulent flow in regurgitation, stenoses, and shunts, enhanced by the implementation of color Doppler; and (4) evaluation of left ventricular diastolic function in conjunction with pulsed tissue Doppler and deformation (strain) measurements.

94 Percutaneous Mitral Repair in Hypertrophic Cardiomyopathy

ObjectivesTo describe our Centre’s experience of percutaneous mitral repair in Hypertrophic Cardiomyopathy (HCM).BackgroundExertional dyspnoea in HCM is multi-factorial. Mitral regurgitation (MR) frequently co-exists with or occurs as a result of...

Hypertrophic Cardiomyopathy

Hypertrophic Cardiomyopathy

Mitral regurgitation in hypertrophic cardiomyopathy: Relationship to obstruction and relief with myectomy: Eric H.C. Yu MD, Ahmad S. Omran MD, E. Douglas Wigle MD, William G. Williams MD, Samuel C. Siu MD, Harry Rakowski MD, The Toronto Hospital, Toronto, Canada

Mitral regurgitation in hypertrophic cardiomyopathy: Relationship to obstruction and relief with myectomy: Eric H.C. Yu MD, Ahmad S. Omran MD, E. Douglas Wigle MD, William G. Williams MD, Samuel C. Siu MD, Harry Rakowski MD, The Toronto Hospital, Toronto, Canada

Transesophageal echocardiographic evaluation of mitral regurgitation in hypertrophic cardiomyopathy: Contributions of eccentric left ventricular hypertrophy and related abnormalities of the mitral complex

This study was designed to evaluate the contribution of eccentric left ventricular hypertrophy and its related organic and spatial abnormalities of the mitral complex to the occurrence of mitral regurgitation in patients with hypertrophic cardiomyopathy We selected 45 consecutive patients with systolic mitral regurgitation by color Doppler echocardiography and performed transesophageal echocardiography in all patients. Eighteen patients were in the obstructive group and 27 patients were in the nonobstructive group of hypertrophic cardiomyopathy with asymmetric septal hypertrophy. Twenty subjects without any cardiac disorders served as the control group. The maximum area of mitral regurgitation was significantly greater in the obstructive group than in the nonobstructive group. Mitral regurgitation appeared more frequently during pansystole in the two groups with hypertrophic cardiomyopathy, particularly in the obstructive group. Mitral valve prolapse was observed in 20 (44%) of the 45 patients with hypertrophic cardiomyopathy. Distances between the posterior papillary muscle and anterior or posterior mitral anulus were significantly smaller in the two groups with hypertrophic cardiomyopathy than in the normal control group. In the obstructive group, the length of the anterior mitral leaflet and the thickness of the rough zone of the anterior mitral leaflet at mid-diastole were significantly greater than in the other groups. Systolic anterior motion was observed in all patients with obstructive cardiomyopathy and contact between the interventricular septum and the anterior mitral leaflet during early diastole was observed in 17 of the 18 patients in the obstructive group.(ABSTRACT TRUNCATED AT 250 WORDS)

Mitral regurgitation in hypertrophic cardiomyopathy. Non-invasive study by two dimensional Doppler echocardiography.

Mitral regurgitation and its haemodynamic features were investigated non-invasively in cases of hypertrophic cardiomyopathy by means of two dimensional Doppler echocardiography. There were 28 patients, 14 of whom showed systolic anterior motion (SAM) of the mitral echo; the other 14 did not. The following results were obtained. (1) Mitral regurgitation was detected by the Doppler technique in all cases with systolic anterior motion of the mitral echo and in half of those without it. (2) Doppler signals of mitral regurgitation started immediately after the first heart sound. (3) Mitral regurgitant flow was often distributed from the entire mitral orifice over the entire or the posterior half of the left atrium in the cases with systolic anterior motion. In the cases without systolic anterior motion the regurgitation was usually localised near the mitral orifice. These features differ from those of regurgitation usually seen in rheumatic mitral valve disease and idiopathic mitral valve prolapse. (4) The Doppler technique and left ventriculography were equally efficient in detecting mitral regurgitation. (5) The early systolic component of the murmur of hypertrophic myopathy is considered to result in the main from concomitant mitral regurgitation, but not from turbulent blood flow in the left ventricular outflow tract, so that in cases with mitral regurgitation as a complication, mitral regurgitation may also contribute to the development of the midsystolic portion of the systolic murmur, while the main origin of this portion of the murmur is the left ventricular outflow obstruction.