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[Hypertrophic cardiomyopathy with midventricular and subvalvular obstruction in both heart ventricles]

V Boewer, G Schröder, J Waigand

    Zeitschrift Fur Kardiologie
    |August 1, 1984
    PubMed

    Insights

    This study details a rare case of combined typical and atypical ventricular obstructions in hypertrophic cardiomyopathy (HCM). The findings highlight complex pressure gradients and morphological changes in both ventricles.

    Area of Science:

    • Cardiology
    • Medical Imaging
    • Pathology

    Background:

    • Hypertrophic cardiomyopathy (HCM) can present with various forms of left ventricular outflow tract obstruction.
    • Typical (subaortic) and atypical (midventricular, apical) obstructions are individually recognized but rarely occur concurrently.

    Observation:

    • A 21-year-old female patient with HCM exhibited rare, simultaneous typical and atypical obstructions in both ventricles.
    • Diagnostic procedures included heart catheterization and angiocardiography, utilizing dual catheters in each ventricle.

    Findings:

    • Significant pressure gradients were recorded in both ventricles, indicating multi-step obstructions.
    • Right ventricle: apical/midventricular (70-100 mm Hg), midventricular/subvalvular (25 mm Hg). Left ventricle: apical/midventricular (70 mm Hg), midventricular/subvalvular (30 mm Hg).
    • Angiography revealed severe bilateral septal hypertrophy, midventricular systolic obstruction, right ventricular infundibular obstruction, apical systolic separation in both ventricles, and left ventricular outflow tract stenosis due to systolic anterior motion of the mitral valve (SAM).

    Implications:

    • This case underscores the potential for complex and combined obstructive patterns in HCM.
    • Accurate diagnosis through advanced imaging is crucial for understanding the pathophysiology and managing such rare presentations.
    • Further research into the mechanisms and clinical outcomes of combined ventricular obstructions in HCM is warranted.

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