Mechanism of left ventricular outflow obstruction in patients with obstructive asymmetric septal hypertrophy (Idiopathic hypertrophic subaortic stenosis)

Henry, Walter L.; Clark, Chester E.; Griffith, James M.; Epstein, Stephen E.

doi:10.1016/0002-9149(75)90025-9

Cited by 204 publications

(51 citation statements)

References 22 publications

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“…We performed echocardiographic studies with the patients in the supine or Henry et al 12 showed that contraction of the misaligned papillary muscles does not cause the abnormal mitral valve motion. They found that forward displacement of the mitral valve narrows the ventricular outflow tract with the onset of systole.…”

Section: Methodsmentioning

confidence: 99%

Systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy.

Mintz¹,

Kotler²,

Segal³

et al. 1978

Circulation

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Section: Methodsmentioning

confidence: 99%

Systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy.

Mintz¹,

Kotler²,

Segal³

et al. 1978

Circulation

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“…Fourteen patients were asymptomatic, two had transient symptoms of chest pain and lightheadedness, and five had moderate-to-severe symptoms (New York Heart Association functional classes IL and III) consisting primarily of functional limitation with dyspnea on exertion and fatigue. Of the 17 study patients 21 years of age or younger, 16 had either no or minimal symptoms. Only one of the 21 patients had a systolic ejection murmur (at the lower left sternal border and apex) that was as loud as grade 3/6; each of the other patients had either no murmur or a soft grade 1-2/6 murmur.…”

Section: Characterization Of Patientsmentioning

confidence: 99%

“…The 21 study patients ranged in age from 5-49 years (mean 16 years); 12 were male and nine were female. Fourteen patients were asymptomatic, two had transient symptoms of chest pain and lightheadedness, and five had moderate-to-severe symptoms (New York Heart Association functional classes IL and III) consisting primarily of functional limitation with dyspnea on exertion and fatigue.…”

Section: Characterization Of Patientsmentioning

confidence: 99%

Hypertrophic cardiomyopathy with unusual locations of left ventricular hypertrophy undetectable by M-mode echocardiography. Identification by wide-angle two-dimensional echocardiography.

Maron¹,

Gottdiener²,

Bonow³

et al. 1981

Circulation

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SUMMARY Twenty-one patients without evidence of hypertrophy by M-mode echocardiography were studied by wide-angle two-dimensional echocardiography to determine if they had a form of hypertrophic cardiomyopathy that could not be detected by conventional M-mode echocardiography. Each patient was suspected clinically of having hypertrophic cardiomyopathy because of a distinctly abnormal ECG and either a family history of hypertrophic cardiomyopathy or cardiac symptoms. Patients were 5-49 years old (mean 16 years) and 16 of the 21 had no functional limitation. The most common electrocardiographic abnormalities were deep Q waves, T-wave inversion and right ventricular hypertrophy. Using wide-angle two-dimensional echocardiography to reconstruct the geometry of the left ventricular wall, 16 of the 21 patients (76%) were shown to have prominent but unusually located regions of left ventricular wall hypertrophy. In each instance, the hypertrophy involved regions of the left ventricular wall through which the M-mode ultrasound beam does not usually pass, i.e., posterior ventricular septum (seven patients), anterior or lateral left ventricular free wall (seven patients) and ventricular septum near the apex (two patients). There was no echocardiographic or hemodynamic evidence of left ventricular outflow tract obstruction in any patient.Hence, some patients with hypertrophic cardiomyopathy may have substantial hypertrophy present in unusual locations of the left ventricular wall. Although electrocardiographic abnormalities suggested the presence of myocardial disease, conventional M-mode echocardiography (performed from standard parasternal positions) did not reliably identify such sites of hypertrophy, which were limited to regions of the left ventricle not accessible to the M-mode beam. Only wide-angle two-dimensional echocardiography permits definitive identification of these unusually located regions of cardiac hypertrophy and confirmation of the diagnosis of hypertrophic cardiomyopathy.HYPERTROPHIC CARDIOMYOPATHY is a disease of cardiac muscle in which the most consistent anatomic feature is a hypertrophied, nondilated left ventricle.' M-mode (one-dimensional) echocardiography is useful for identifying asymmetric septal hypertrophy,2 10 the characteristic gross anatomic feature of hypertrophic cardiomyopathy. However, we recently evaluated several patients in whom the diagnosis of hypertrophic cardiomyopathy was suspected clinically (primarily because of a distinctly abnormal ECG and a family history of hypertrophic cardiomyopathy), but conventional M-mode echocardiography did not show left ventricular hypertrophy. Such patients present the diagnostic problem of whether they have a form of hypertrophic cardiomyopathy that cannot be detected by M-mode echocardiography. Because wide-angle two-dimensional echocardiography affords visualization of portions of the left ventricular wall inaccessible to the Mmode ultrasound beam, we studied patients using thatFrom the Cardiology Branch,

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“…The precise mechanism for SAM is not clear and is still controversial (Wynne and Braunwald, 1984). Three explanations have been suggested for SAM: First a Venturi effect in the left venticular outflow tract (Wigle et al, 1971); second, impingement of the mitral valve against the septum because of its abnormal position in the left ventricular outflow tract (Henry, 1975); third, that the mitral valve is pulled against the septum by contraction of the papillary muscle because of abnormal location and orientation of these muscles resulting from septa1 hypertrophy (Reis et al, 1974;Wynne and Braunwald, 1984).…”

Section: Discussionmentioning

confidence: 99%

Midventricular obstruction—A form of hypertrophic obstructive cardiomyopathy—and systolic anterior motion of the mitral valve

Sheikhzadeh

Eslami

Stierle³

et al. 1986

Clinical Cardiology

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Summary: Hypertrophic cardiomyopathy (HCM) has various manifestations with respect to the localization of the hypertrophy. In this study we report clinical, electrocardiographic (ECG), echocardiographic (echo), and hemodynamic findings in midventricular obstruction (MO), an uncommon form of hypertrophic obstructive cardiomyopathy (HOCM) in 9 patients. The prevalence of systolic anterior motion of anterior mitral leaflet (SAM) in MO, an echocardiographic diagnostic hallmark in HOCM, was another purpose of this study. All patients had complete clinical, ECG, echo, and hemodynamic workup, including left ventricular (in 4 patients simultaneous biventricular, SBVA) and coronary angiograms. All patients had dyspnea and palpitations, chest pain, 2 had syncope. In the ECG, atrial fibrillation was present in 2 , and left ventricular hypertrophy in 9 patients. Septa1 and left ventricular free wall thickening was significantly present in all patients in echo, and SAM in 1 patient. The intraventricular gradient (IVG) was 40-1 76 mmHg, in I case 40 mmHg by provocation, Brockenbrough was positive in all patients. Two patients had right ventricular IVG. A positive beta-blocking agent effect was present in 6 cases. The best localization of the obstruction was possible with SBVA and 2D-echo. We conclude that M O has all the signs of HOCM, but S A M in echocardiography is uncommon. S A M is occasionally present and is not a necessary factor to pro-

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Mechanism of left ventricular outflow obstruction in patients with obstructive asymmetric septal hypertrophy (Idiopathic hypertrophic subaortic stenosis)

Cited by 204 publications

References 22 publications

Systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy.

Systolic anterior motion of the mitral valve in the absence of asymmetric septal hypertrophy.

Hypertrophic cardiomyopathy with unusual locations of left ventricular hypertrophy undetectable by M-mode echocardiography. Identification by wide-angle two-dimensional echocardiography.

Midventricular obstruction—A form of hypertrophic obstructive cardiomyopathy—and systolic anterior motion of the mitral valve

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