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[Anomalous insertion of mitral papillary muscles in obstructive hypertrophic myocardiopathy. Report of 2 cases]
J Queiróz e Melo1, M Canada, J Neves
1Serviços de Cardiologia e de Cirurgia Cardiaca do Hospital de Santa Cruz, Carnaxide, Portugal.
Insights
Transesophageal echocardiography aids in diagnosing hypertrophic obstructive cardiomyopathy by identifying abnormal papillary muscles. This allows for muscle excision instead of mitral valve replacement, improving patient outcomes.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents complex features requiring surgical intervention, often myectomy.
- Mitral valve abnormalities contributing to left ventricle outflow obstruction typically necessitate valve replacement.
Observation:
- Transesophageal echocardiography (TEE) provided detailed visualization of the mitral valve and left ventricle outflow tract.
- Two cases revealed anomalous papillary muscles inserting directly into the anterior mitral valve leaflet, causing severe obstruction.
Findings:
- Surgical treatment involved septal myectomy and excision of the anomalous papillary muscles.
- This approach successfully relieved the left ventricle outflow obstruction and prevented the need for mitral valve replacement.
Implications:
- Preoperative identification of anomalous papillary muscles via TEE can guide surgical strategy in HOCM.
- Avoiding mitral valve replacement through targeted muscle excision offers a potentially less invasive treatment option for select HOCM patients.
Abstract:
Hypertrophic obstructive cardiomyopathy is a pathologic entity whose features are complex and diverse. Its surgical treatment generally requires myectomy. When the left ventricle outflow gradient is also due to mitral valve abnormalities, mitral valve replacement has been considered as the treatment of choice for the relief of the obstruction. We report two cases in which transesophageal echocardiography has allowed a good definition of this complex area of the heart and a better diagnosis and treatment of its components. Its use led to the diagnosis of abnormal papillary muscles inserted directly in the anterior leaflet of the mitral valve, with severe left ventricle outflow obstruction. Surgical treatment consisted of septal myectomy and excision of the muscles, thus preventing the need for mitral replacement. Systolic anterior motion of the mitral valve subsided and the outflow gradients became negligible. This new approach for the treatment of hypertrophic obstructive cardiomyopathy will be of benefit for patients in whom the anomalous insertion of the papillary muscles are recognized before surgery, thus preventing mitral valve replacement.