Magnetic Resonance Contrast Enhancement of Iatrogenic Septal Myocardial Infarction in Hypertrophic Cardiomyopathy
A 80-year-old woman with hypertrophic cardiomyopathy (HCM) was referred to the cardiovascular magnetic resonance unit for assessment of cardiac function. Six months previously, she had presented with breathlessness. Echocardiography had demonstrated a dynamic left ventricular outflow tract gradient of 80 mm Hg at rest, rising to 160 mm Hg after a ventricular extrasystole. The patient had undergone transcatheter septal ablation by the injection of 0.8 mL of absolute alcohol into the first septal branch of the left anterior descending coronary artery (LAD) 2 months before imaging. During the procedure, the gradient dropped to zero. Since then, she had improved from New York Heart Association class III to class I.
Cardiovascular magnetic resonance was performed. Gradient-echo cine imaging demonstrated proximal interven-tricular septal hypokinesis and relative thinning (Figure 1) with no systolic anterior motion of the anterior mitral valve leaflet and no left ventricular outflow tract turbulence. After bolus injection of gadolinium-DTPA, delayed enhancement imaging was performed using the inversion recovery technique. There was focal hyperenhancement at the site of the wall motion abnormality (Figure 2), corresponding to the former territory of the first septal branch vessel.
This case illustrates the in vivo imaging by cardiovascular magnetic resonance of iatrogenic myocardial infarction, performed using a combination of functional cine imaging and delayed contrast enhancement in a successful case of transcatheter septal ablation in HCM.
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.
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