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Left ventricular outflow tract obstruction due to anomalous insertion of papillary muscle

Tetsuya Nomura1, Yoshiaki Harada, Yoko Suzaki

  • 1Department of Cardiology, Maizuru Medical Center, Yukinaga, Maizuru, Japan. prinom@eos.ocn.ne.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|November 27, 2004
PubMed

Insights

Anomalous papillary muscle in the heart can cause left ventricular outflow tract (LVOT) obstruction, leading to serious symptoms. Surgical correction of this rare condition effectively resolved the obstruction and associated complications.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Left ventricular outflow tract (LVOT) obstruction can arise from various causes, including rare anatomical abnormalities.
  • Accessory papillary muscles can abnormally encroach upon the LVOT, potentially leading to hemodynamic compromise.

Observation:

  • A 56-year-old man presented with quadrantic hemianopsia, attributed to a cerebral embolism likely secondary to arrhythmia.
  • Echocardiography revealed a hypertrophied anterolateral papillary muscle causing direct continuity with the anterior mitral leaflet, narrowing the LVOT.
  • The LVOT obstruction resulted in intra-LV pressure overload and concentric left ventricular hypertrophy.

Findings:

  • Cerebral angiography excluded organic stenosis as the cause of hemianopsia.
  • Surgical intervention included mitral valve replacement, septal myectomy, and myectomy of the abnormal papillary muscle.
  • Complete release of the LVOT obstruction was achieved, resolving the patient's condition.

Implications:

  • Anomalous papillary muscle insertion is a rare but significant cause of LVOT obstruction.
  • Echocardiography is a valuable diagnostic tool for identifying papillary muscle malformations.
  • Surgical management of this anomaly can be curative, preventing further embolic events and hemodynamic dysfunction.

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