Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy.

Autor:	Taquiso JL; Section of Cardiology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines., Obillos SMO; Section of Cardiology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines., Mojica JV; Section of Cardiology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines., Abrahan LL 4th; Section of Cardiology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines., Cunanan EC; Section of Cardiology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines., Aherrera JAM; Section of Cardiology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines., Magno JDA; Section of Cardiology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Manila, Philippines.
Jazyk:	angličtina
Zdroj:	Cardiology research [Cardiol Res] 2017 Oct; Vol. 8 (5), pp. 258-264. Date of Electronic Publication: 2017 Oct 27.
DOI:	10.14740/cr614w
Abstrakt:	Systolic anterior motion (SAM) of the mitral valve or chordate is one characteristic seen in hypertrophic cardiomyopathy (HCM) either in obstructive or non-obstructive phenotypes. More often than not, the obstruction is caused by valvular rather than chordal SAM. We describe the role of echocardiography in identifying the actual anatomical location of the mitral valve apparatus involved in SAM and in assessing consequent left ventricular outflow tract (LVOT) obstruction in an otherwise asymptomatic patient. We report a case of a 29-year-old male admitted for an elective non-cardiac surgery, presenting with a cardiac murmur and left axis deviation with biventricular hypertrophy on electrocardiogram. On 2D transthoracic echocardiography (TTE), an asymmetrically hypertrophied left ventricle with systolic motion of anterior mitral valve was incidentally seen. Continuous wave Doppler assessment across the LVOT showed some gradient of obstruction (peak gradient: 9 mm Hg). Transesophageal echocardiography (TEE) demonstrated a redundant anterior mitral valve with the subchordal apparatus mainly causing SAM and confirmed the gradient obtained on TTE, with a mild degree, yet non-significant, degree of LVOT obstruction (mean gradient: 10 mm Hg) documented. Because of this finding, patient was cleared for surgery. Management was deemed conservative with emphasis on close surveillance for signs and symptoms attributable to development of significant LVOT obstruction in patients with HCM. To our knowledge, this is the first reported case in our country of an echocardiographic pattern of systolic anterior motion primarily of the subchordal mitral valve apparatus causing some, though non-significant, degree of LVOT obstruction in HCM. Echocardiographic features such as asymmetric left ventricular hypertrophy and presence of some LVOT obstruction caused primarily by subchordal apparatus could impact management in asymptomatic patients. Competing Interests: The corresponding author and co-authors declare no conflict of interest related directly or indirectly in the writing of this manuscript.
Databáze:	MEDLINE
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