title: Left ventricular outflow tract obstruction due to anomalous insertion of papillary muscle.
abstract: A 56-year-old man who complained of quadrantic hemianopsia was admitted to determine its etiology. Cerebral angiography revealed no organic stenosis. Echocardiography showed clear direct continuity between a hypertrophied anterolateral papillary muscle and the anterior mitral leaflet, and the left ventricular (LV) outflow tract (LVOT) was narrowed by the presence of an accessory papillary muscle. The LVOT obstruction caused an intra-LV pressure overload that resulted in LV concentric hypertrophy. Arrhythmia, such as paroxysmal atrial fibrillation (PAF), was thought to have caused a cerebral embolism. Mitral valve replacement (MVR), septal myectomy, and myectomy of the abnormal papillary muscle were performed, and complete release of the LVOT obstruction was accomplished. Anomalous insertion of papillary muscle is a rare cause of LVOT obstruction. Echocardiography was useful in identifying the papillary muscle malformation, and surgery was completely curative.
authors.affiliation: Department of Cardiology, Maizuru Medical Center, Yukinaga, Maizuru, Japan. prinom@eos.ocn.ne.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Nomura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Harada
authors.forename: Yoko
authors.initials: Y
authors.lastname: Suzaki
authors.forename: Hironori
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Jun
authors.initials: J
authors.lastname: Shiraishi
authors.forename: Sumio
authors.initials: S
authors.lastname: Komatsu
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Hosomi
authors.forename: Shinji
authors.initials: S
authors.lastname: Hirano
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yaku
authors.forename: Nobuo
authors.initials: N
authors.lastname: Kitamura
mesh_terms: D002544:Cerebral Infarction / Q000209:etiology; D004452:Echocardiography; D006350:Heart Valve Prosthesis; D006423:Hemianopsia / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D010210:Papillary Muscles / Q000002:abnormalities* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery