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Published on: May 19, 2020
The Role of Mitral Valve in Hypertrophic Obstructive Cardiomyopathy: An Updated Review
Insights
Hypertrophic cardiomyopathy (HCM), a common inherited heart condition, often leads to sudden death in young athletes. Mitral valve abnormalities are key diagnostic indicators and targets for surgical repair in HCM patients.
Area of Science:
- Cardiology
- Genetics
- Cardiac Surgery
Background:
- Hypertrophic cardiomyopathy (HCM) is the leading inherited heart disease and cause of sudden cardiac death in individuals under 35.
- Genetic mutations, primarily in the beta-myosin heavy chain and cardiac myosin-binding protein C genes, underlie HCM.
- Mitral valve abnormalities can be primary indicators of HCM, even preceding significant cardiac hypertrophy.
Purpose of the Study:
- To review the critical role of mitral valve apparatus examination in diagnosing and managing HCM.
- To highlight the significance of mitral valve abnormalities in HCM pathogenesis and treatment strategies.
Main Methods:
- Review of current literature on hypertrophic cardiomyopathy and mitral valve abnormalities.
- Emphasis on diagnostic imaging modalities, including echocardiography and cardiac MRI.
- Analysis of surgical approaches for obstruction relief in HCM.
Main Results:
- Mitral valve abnormalities such as elongated leaflets and systolic anterior motion are crucial diagnostic markers for HCM.
- Echocardiography remains the gold standard, while MRI aids in diagnosis and risk stratification.
- Surgical repair of mitral valve abnormalities is a fundamental aspect of HCM management.
Conclusions:
- Mitral valve abnormalities are integral to HCM, influencing systolic anterior motion and requiring surgical consideration.
- Effective obstruction relief in HCM may necessitate combined septal myectomy and mitral valve repair.
Abstract:
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease and the most common cause of sudden cardiac death in young population, especially in athletes under 35 years old. Mutations occur primarily in the β-myosin heavy chain gene and involve the cardiac myosin-binding protein C gene. In this review we would like to focus on the importance of the examination of mitral valve apparatus and the mitral valve abnormalities in patients with HCM. Abnormalities in mitral valve (elongated mitral leaflets, displacement of papillary muscles, and systolic anterior motion) may be the primary pathognomonic elements, even in the absence of hypertrophy. Echocardiography is the gold standard for the diagnosis of HCM. Magnetic resonance imaging emerges as one of the most important imaging modalities for precise diagnosis, assisting in risk stratification and treatment strategy. Mitral valve abnormalities take part fundamentally in the formation of systolic anterior motion of the mitral valve and, they have substantially been repaired surgically. Although myectomy addresses the septum reduction, obstruction relief should be maximally achieved with a potential combination of myectomy and mitral valve repair.
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