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Mitral valve and papillary muscle abnormalities in hypertrophic obstructive cardiomyopathy
Eliza P Teo1, Jonathan G Teoh, Judy Hung
1Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Mitral valve abnormalities are common in hypertrophic obstructive cardiomyopathy (HOCM). These changes, including leaflet and papillary muscle issues, contribute to the obstruction of blood flow in HOCM.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathophysiology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a complex cardiac condition.
- The mitral valve apparatus plays a critical role in HOCM pathophysiology.
Purpose of the Study:
- To review mitral valve abnormalities associated with hypertrophic obstructive cardiomyopathy.
- To elucidate the role of these abnormalities in dynamic left ventricular outflow tract obstruction.
Main Methods:
- Literature review of studies focusing on mitral valve morphology in HOCM.
- Analysis of the functional impact of mitral valve changes on left ventricular outflow tract dynamics.
Main Results:
- Common mitral valve abnormalities include leaflet elongation/thickening and anterior papillary muscle displacement.
- These abnormalities promote systolic anterior motion (SAM) of the mitral valve.
- SAM leads to reduced leaflet coaptation, resulting in mitral regurgitation and contributing to outflow tract obstruction.
Conclusions:
- Mitral valve abnormalities are frequently observed in patients with HOCM.
- These structural changes are integral to the development of dynamic left ventricular outflow tract obstruction in HOCM.
Purpose Of Review:
This section reviews abnormalities of the mitral valve apparatus that are associated with hypertrophic obstructive cardiomyopathy.
Recent Findings:
Mitral valve abnormalities in hypertrophic obstructive cardiomyopathy include leaflet elongation and thickening and hypertrophy with anterior displacement of the papillary muscles. This combination contributes to the development of systolic anterior motion. The resultant flow forces during systolic anterior motion pulling the leaflets into the left ventricular outflow tract also result in reduced leaflet coaptation and a posteriorly directed mitral regurgitant jet. Additional mitral valve abnormalities include degenerative leaflet changes, aberrant chordal attachments and papillary muscle anomalies.
Summary:
Mitral valve abnormalities are common in hypertrophic obstructive cardiomyopathy and play an important role in the pathophysiology of dynamic left ventricular outflow tract obstruction.
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