title: Papillary muscle insertion directly into the anterior mitral leaflet in hypertrophic cardiomyopathy, its identification and cause of outflow obstruction by cardiac magnetic resonance imaging, and its surgical management.
abstract: This case presents an uncommon but important mechanism of muscular left ventricular outflow obstruction in hypertrophic cardiomyopathy due to anomalous and direct papillary muscle insertion into the anterior mitral leaflet, a finding reliably identified clinically by cardiac magnetic resonance imaging. The identification of this left ventricular outflow tract morphology is important before invasive ventricular septal reduction therapy because it dictates a specific surgical strategy. These findings further support the role of cardiac magnetic resonance imaging in the early evaluation of hypertrophic cardiomyopathy patients.
authors.affiliation: Hypertrophic Cardiomyopathy Center, Division of Cardiology, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Ethan J
authors.initials: EJ
authors.lastname: Rowin
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Maron
authors.forename: John R
authors.initials: JR
authors.lastname: Lesser
authors.forename: Hassan
authors.initials: H
authors.lastname: Rastegar
authors.forename: Martin S
authors.initials: MS
authors.lastname: Maron
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000002:abnormalities*; D010210:Papillary Muscles / Q000002:abnormalities*; D014694:Ventricular Outflow Obstruction / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery