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Multimodality Imaging Demonstrating an Apical Variant Hypertrophic Cardiomyopathy in an Uncommon Pentad
Ayman R Fath1, Clinton E Jokerst1, Amro Aglan2
1Mayo Clinic Arizona, Phoenix, AZ, USA.
Insights
This study details a case of apical variant hypertrophic cardiomyopathy discovered during transcatheter aortic valve replacement. Findings included an apical aneurysm, left ventricular gradients, and ascending aorta dilatation.
Area of Science:
- Cardiology
- Cardiac Imaging
- Cardiovascular Surgery
Background:
- Severe aortic stenosis necessitates intervention, often transcatheter aortic valve replacement (TAVR).
- Apical variant hypertrophic cardiomyopathy (HCM) is a distinct form of HCM characterized by apical thickening and specific imaging findings.
- Pre-procedural imaging is crucial for identifying complex cardiac anatomy and comorbidities.
Abstract:
A 79-year-old man was admitted for a transcatheter aortic valve replacement due to severe aortic stenosis. A preoperative chest computed tomography with angiography revealed an apical variant hypertrophic cardiomyopathy with a prominent apical pouch. In addition, there was near-complete obliteration of the left ventricle in the mid to apical aspect during systole suggesting a midventricular gradient. Postoperative transthoracic echocardiography confirmed the apical variant hypertrophic cardiomyopathy with an apical aneurysm and a gradient with a peak velocity of 2 m/s, and mid-cavitary gradient with a peak velocity of 3 m/s. It also revealed a fusiform aneurysmal dilatation of the ascending aorta.
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