Cargando…

Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy

Systolic anterior motion (SAM) of the mitral valve or chordate is one characteristic seen in hypertrophic cardiomyopathy (HCM) either in obstructive or non-obstructive phenotypes. More often than not, the obstruction is caused by valvular rather than chordal SAM. We describe the role of echocardiogr...

Descripción completa

Detalles Bibliográficos
Autores principales: Taquiso, Jezreel L., Obillos, Stephanie Martha O., Mojica, Joerelle V., Abrahan, Lauro L., Cunanan, Elleen C., Aherrera, Jaime Alfonso M., Magno, Jose Donato A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elmer Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667716/
https://www.ncbi.nlm.nih.gov/pubmed/29118891
http://dx.doi.org/10.14740/cr614w
_version_ 1783275537637048320
author Taquiso, Jezreel L.
Obillos, Stephanie Martha O.
Mojica, Joerelle V.
Abrahan, Lauro L.
Cunanan, Elleen C.
Aherrera, Jaime Alfonso M.
Magno, Jose Donato A.
author_facet Taquiso, Jezreel L.
Obillos, Stephanie Martha O.
Mojica, Joerelle V.
Abrahan, Lauro L.
Cunanan, Elleen C.
Aherrera, Jaime Alfonso M.
Magno, Jose Donato A.
author_sort Taquiso, Jezreel L.
collection PubMed
description Systolic anterior motion (SAM) of the mitral valve or chordate is one characteristic seen in hypertrophic cardiomyopathy (HCM) either in obstructive or non-obstructive phenotypes. More often than not, the obstruction is caused by valvular rather than chordal SAM. We describe the role of echocardiography in identifying the actual anatomical location of the mitral valve apparatus involved in SAM and in assessing consequent left ventricular outflow tract (LVOT) obstruction in an otherwise asymptomatic patient. We report a case of a 29-year-old male admitted for an elective non-cardiac surgery, presenting with a cardiac murmur and left axis deviation with biventricular hypertrophy on electrocardiogram. On 2D transthoracic echocardiography (TTE), an asymmetrically hypertrophied left ventricle with systolic motion of anterior mitral valve was incidentally seen. Continuous wave Doppler assessment across the LVOT showed some gradient of obstruction (peak gradient: 9 mm Hg). Transesophageal echocardiography (TEE) demonstrated a redundant anterior mitral valve with the subchordal apparatus mainly causing SAM and confirmed the gradient obtained on TTE, with a mild degree, yet non-significant, degree of LVOT obstruction (mean gradient: 10 mm Hg) documented. Because of this finding, patient was cleared for surgery. Management was deemed conservative with emphasis on close surveillance for signs and symptoms attributable to development of significant LVOT obstruction in patients with HCM. To our knowledge, this is the first reported case in our country of an echocardiographic pattern of systolic anterior motion primarily of the subchordal mitral valve apparatus causing some, though non-significant, degree of LVOT obstruction in HCM. Echocardiographic features such as asymmetric left ventricular hypertrophy and presence of some LVOT obstruction caused primarily by subchordal apparatus could impact management in asymptomatic patients.
format Online
Article
Text
id pubmed-5667716
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Elmer Press
record_format MEDLINE/PubMed
spelling pubmed-56677162017-11-08 Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy Taquiso, Jezreel L. Obillos, Stephanie Martha O. Mojica, Joerelle V. Abrahan, Lauro L. Cunanan, Elleen C. Aherrera, Jaime Alfonso M. Magno, Jose Donato A. Cardiol Res Case Report Systolic anterior motion (SAM) of the mitral valve or chordate is one characteristic seen in hypertrophic cardiomyopathy (HCM) either in obstructive or non-obstructive phenotypes. More often than not, the obstruction is caused by valvular rather than chordal SAM. We describe the role of echocardiography in identifying the actual anatomical location of the mitral valve apparatus involved in SAM and in assessing consequent left ventricular outflow tract (LVOT) obstruction in an otherwise asymptomatic patient. We report a case of a 29-year-old male admitted for an elective non-cardiac surgery, presenting with a cardiac murmur and left axis deviation with biventricular hypertrophy on electrocardiogram. On 2D transthoracic echocardiography (TTE), an asymmetrically hypertrophied left ventricle with systolic motion of anterior mitral valve was incidentally seen. Continuous wave Doppler assessment across the LVOT showed some gradient of obstruction (peak gradient: 9 mm Hg). Transesophageal echocardiography (TEE) demonstrated a redundant anterior mitral valve with the subchordal apparatus mainly causing SAM and confirmed the gradient obtained on TTE, with a mild degree, yet non-significant, degree of LVOT obstruction (mean gradient: 10 mm Hg) documented. Because of this finding, patient was cleared for surgery. Management was deemed conservative with emphasis on close surveillance for signs and symptoms attributable to development of significant LVOT obstruction in patients with HCM. To our knowledge, this is the first reported case in our country of an echocardiographic pattern of systolic anterior motion primarily of the subchordal mitral valve apparatus causing some, though non-significant, degree of LVOT obstruction in HCM. Echocardiographic features such as asymmetric left ventricular hypertrophy and presence of some LVOT obstruction caused primarily by subchordal apparatus could impact management in asymptomatic patients. Elmer Press 2017-10 2017-10-27 /pmc/articles/PMC5667716/ /pubmed/29118891 http://dx.doi.org/10.14740/cr614w Text en Copyright 2017, Taquiso et al. http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Taquiso, Jezreel L.
Obillos, Stephanie Martha O.
Mojica, Joerelle V.
Abrahan, Lauro L.
Cunanan, Elleen C.
Aherrera, Jaime Alfonso M.
Magno, Jose Donato A.
Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy
title Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy
title_full Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy
title_fullStr Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy
title_full_unstemmed Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy
title_short Systolic Anterior Motion of Mitral Valve Subchordal Apparatus: A Rare Echocardiographic Pattern in Non-Obstructive Hypertrophic Cardiomyopathy
title_sort systolic anterior motion of mitral valve subchordal apparatus: a rare echocardiographic pattern in non-obstructive hypertrophic cardiomyopathy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5667716/
https://www.ncbi.nlm.nih.gov/pubmed/29118891
http://dx.doi.org/10.14740/cr614w
work_keys_str_mv AT taquisojezreell systolicanteriormotionofmitralvalvesubchordalapparatusarareechocardiographicpatterninnonobstructivehypertrophiccardiomyopathy
AT obillosstephaniemarthao systolicanteriormotionofmitralvalvesubchordalapparatusarareechocardiographicpatterninnonobstructivehypertrophiccardiomyopathy
AT mojicajoerellev systolicanteriormotionofmitralvalvesubchordalapparatusarareechocardiographicpatterninnonobstructivehypertrophiccardiomyopathy
AT abrahanlaurol systolicanteriormotionofmitralvalvesubchordalapparatusarareechocardiographicpatterninnonobstructivehypertrophiccardiomyopathy
AT cunananelleenc systolicanteriormotionofmitralvalvesubchordalapparatusarareechocardiographicpatterninnonobstructivehypertrophiccardiomyopathy
AT aherrerajaimealfonsom systolicanteriormotionofmitralvalvesubchordalapparatusarareechocardiographicpatterninnonobstructivehypertrophiccardiomyopathy
AT magnojosedonatoa systolicanteriormotionofmitralvalvesubchordalapparatusarareechocardiographicpatterninnonobstructivehypertrophiccardiomyopathy