[Anomalous insertion of mitral papillary muscles in obstructive hypertrophic myocardiopathy. Report of 2 cases].
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.
Queiróz e Melo
J
J
Serviços de Cardiologia e de Cirurgia Cardiaca do Hospital de Santa Cruz, Carnaxide, Portugal.
Canada
M
M
Neves
J
J
Ferreira
M M
MM
de Sousa
J S
JS
Ribeiras
R
R
Rebocho
M J
MJ
de Santos
J C
JC
Seabra-Gomes
R
R
D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging; D010210:Papillary Muscles / Q000002:abnormalities*; D014463:Ultrasonography
Insercão anómala de músculos papilares mitrais na miocardiopatia hipertrófica obstrutiva. A propósito de dois casos.