This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Doshi, S. N. Articles by Fuster, V. Search for Related Content PubMed PubMed Citation Articles by Doshi, S. N. Articles by Fuster, V. Related Collections Cardiovascular imaging agents/Techniques Hypertrophy Myocardial cardiomyopathy disease Coronary imaging: angiography/ultrasound/Doppler/CC

(Circulation. 2002;106:e3.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Right and Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy

Sagar N. Doshi, BSc, MBChB, MRCP; Michael C. Kim, MD; Samin K. Sharma, MD; Valentin Fuster, MD, PhD

From The Cardiac Catheterization Laboratory of the Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY.

Correspondence to Dr Sagar N. Doshi, MD, The Cardiovascular Institute, Mount Sinai School of Medicine, Box 1030, One Gustave L Levy Place, New York, NY 10029-6574. E-mail Sagar.Doshi{at}msnyuhealth.org

Hypertrophic obstructive cardiomyopathy (HOCM) affecting both the right and left ventricular (RV and LV) outflow tracts is rare, and the mechanism of obstruction is different in each ventricle. A 21-year-old man with a family history of HOCM and sudden death was referred with breathlessness (New York Heart Association grade II) and occasional presyncope. There had been no discharges of an implantable defibrillator inserted 2 years earlier, and the sole medication was a ß-blocker. A transthoracic echocardiogram revealed marked, bilateral ventricular hypertrophy. Doppler revealed a 70 mm Hg LV outflow gradient and obstruction of the right outflow tract at rest. Right and left heart catheterization, with simultaneous central aortic and LV pressure recording, revealed a 100 mm Hg subaortic gradient (Figure, a) and a 75 mm Hg subpulmonic gradient at rest (Figure, b and c). Ventriculography confirmed that the obstruction of the LV outflow was due to systolic anterior mitral valve movement (Figure, d and e), whereas RV outflow obstruction was due to massive hypertrophy of the crista supraventricularis (Figure, f).

View larger version (67K): [in this window] [in a new window]   a, Simultaneous pressure recordings from the mid LV cavity and central aorta show a 100 mm Hg gradient. The aortic trace shows a "spike and dome" pattern due to systolic anterior mitral valve movement, which impedes late systolic ejection. Pullback from the central LV cavity confirms that the gradient is subaortic. b and c, Pullback from the pulmonary artery (PA) reveals a 75 mm Hg subpulmonic gradient. d and e, Left ventriculogram (right anterior oblique projection). Arrows show systolic anterior mitral valve movement obstructing outflow in late systole. AO indicates aorta. f, Right ventriculogram (left lateral projection) demonstrates massive hypertrophy of the RV outflow (arrows) with an "hour-glass" deformity.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This article has been cited by other articles:

				A. Y. Denault, M. Chaput, P. Couture, Y. Hebert, F. Haddad, and J.-C. Tardif Dynamic right ventricular outflow tract obstruction in cardiac surgery J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 43 - 49. [Abstract] [Full Text] [PDF]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Doshi, S. N. Articles by Fuster, V. Search for Related Content PubMed PubMed Citation Articles by Doshi, S. N. Articles by Fuster, V. Related Collections Cardiovascular imaging agents/Techniques Hypertrophy Myocardial cardiomyopathy disease Coronary imaging: angiography/ultrasound/Doppler/CC