title: Anomalous insertion of the papillary muscle causing left ventricular outflow obstruction: visualization by real-time three-dimensional echocardiography.
abstract: Anomalous insertion of the papillary muscle (PM)/chordae tendineae is a rare but important cause of dynamic left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy or cardiac amyloidosis. These anomalies are often challenging to diagnose with 2-D Echo, yet accurate diagnosis is critical in determining whether to proceed with an extended septal myectomy instead of a standard septal myectomy for relief. We report two cases of anomalous insertion of the PM causing LVOT obstruction with diagnosis facilitated by real-time 3-D echocardiograms.
authors.affiliation: Division of Cardiovascular Diseases, Mayo College of Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
authors.forename: Hyun Suk
authors.initials: HS
authors.lastname: Yang
authors.forename: Kwan S
authors.initials: KS
authors.lastname: Lee
authors.forename: Hari P
authors.initials: HP
authors.lastname: Chaliki
authors.forename: Henry D
authors.initials: HD
authors.lastname: Tazelaar
authors.forename: Joan L
authors.initials: JL
authors.lastname: Lusk
authors.forename: Krishnaswamy
authors.initials: K
authors.lastname: Chandrasekaran
authors.forename: A Jamil
authors.initials: AJ
authors.lastname: Tajik
mesh_terms: D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging; D019560:Echocardiography, Three-Dimensional; D006801:Humans; D008297:Male; D010210:Papillary Muscles / Q000002:abnormalities*; D012680:Sensitivity and Specificity; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology