Mid-ventricular obstructive hypertrophic cardiomyopathy associated with an apical aneurysm: evaluation of possible causes of aneurysm formation.
Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is a rare type of cardiomyopathy, associated with apical aneurysm formation in some cases. We report a patient presenting with ventricular fibrillation, an ECG with an above normal ST segment, and elevated levels of cardiac enzymes but normal coronary arteries. Left ventriculography revealed a left ventricular obstruction without apical aneurysm. There was a significant pressure gradient between the apical and basal sites of the left ventricle. Cine magnetic resonance imaging (MRI), performed on the 10th hospital day, showed asymmetric septal hypertrophy, mid-ventricular obstruction, and an apical aneurysm with a thrombus. The first evaluation by contrast-enhanced imaging showed a subendocardial perfusion defect and delayed enhancement. It was speculated that the intraventricular pressure gradient, due to mid- ventricular obstruction, triggered myocardial infarction, which subsequently resulted in apical aneurysm formation.
Sato
Yuichi
Y
Department of Cardiology, Nihon University School of Medicine, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo, Japan. yuichis@med.nihon-u.ac.jp
Matsumoto
Naoya
N
Matsuo
Shinro
S
Yoda
Shunichi
S
Tani
Shigemasa
S
Kasamaki
Yuji
Y
Takayama
Tadateru
T
Kunimoto
Satoshi
S
Saito
Satoshi
S
D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis*; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D006322:Heart Aneurysm / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000175:diagnosis*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis