Solitary accessory and papillary muscle hypertrophy manifested as dynamic mid-wall obstruction and symptomatic heart failure: diagnostic feasibility by multi-modality imaging

Abstract

BackgroundSolitary papillary muscle (PM) hypertrophy is an unique type of hypertrophic cardiomyopathy (HCM), which is characterized by predominant papillary muscle hypertrophy sparing the rest of other left ventricular segments. It has recently drawn our attention about the mechanism of left ventricular mid-cavity obstruction and the influence of pressure gradient in the left ventricular outflow tract (LVOT), thus carries clinical importance.Case presentationWe reported a symptomatic, 83-year-old woman who presented with dynamic, high resting left ventricle (LV) mid-wall gradient without obvious septal hypertrophy or systolic anterior motion (SAM). Subsequent real-time (RT) three-dimensional echocardiography (3DE) and cardiac magnetic resonance imaging (MRI) demonstrated large, hypertrophic accessory papillary muscles squeezing mid-cavity of left ventricle producing dynamic pressure gradient during systole in the absence of left ventricular wall anomalies.ConclusionWe proposed that combined use of echocardiography particularly RT-3DE and cardiac magnetic resonance imaging (MRI) can accurately identify this specific type of hypertrophic cardiomyopathy without remarkable traditional features.

Incremental Value of Live/Real Time Three‐Dimensional Transthoracic Echocardiography over Two‐Dimensional Echocardiography in Hypertrophic Cardiomyopathy with Mid‐Ventricular Obstruction and Apical Aneurysm

“…In another report, a patient with HCM and a high mid‐LV gradient had solitary papillary muscle hypertrophy diagnosed by 2DTTE. 3DTTE was then used to clarify the spatial relationships between these hypertrophied papillary muscles …”

“…3DTTE was then used to clarify the spatial relationships between these hypertrophied papillary muscles. 9 In the current patient studied by us, 3DTTE provided a more comprehensive assessment of the apical aneurysm as compared to 2DTTE, which provides at any given time only a thin slice of a structure being studied. With 3DTTE, the entire extent of the aneurysm was contained in the 3D dataset so that it could be more fully studied using multiple cross sections at any desired angulation.…”

Magnetic resonance imaging of the papillary muscles of the left ventricle: normal anatomy, variants, and abnormalities

“…Solitary papillary muscle hypertrophy is a unique phenotype of HCM that is seen in 19 to 20% of patients. In this condition, the papillary muscles are hypertrophied but the rest of the left ventricular myocardium is spared [39, 40]. These patients present with angina, dyspnea, syncope, and sudden cardiac death [40].…”

“…In this condition, the papillary muscles are hypertrophied but the rest of the left ventricular myocardium is spared [39, 40]. These patients present with angina, dyspnea, syncope, and sudden cardiac death [40]. On CMR images, hypertrophic papillary muscles may demonstrate dynamic mid-cavity obstruction and flow acceleration within the LV (Fig.…”

Three Achilles’ heels of alcohol septal ablation

“…Только описание [63] добавочные папиллярные мышцы Только описание [62] апикальное (переднее) смещение папиллярных мышц Доказано в исследовании [56] бифуркация (расщепление) головок папиллярных мышц Доказано в исследовании [56] Створки митрального клапана избыточная длина передней митральной створки Доказано в исследовании [27,28] избыточная длина задней митральной створки Только описание [67] Сухожильные хорды «слабость» (избыточная длина) хорд…”