title: Dynamic obstruction in hypertrophic cardiomyopathy.
abstract: OBJECTIVE
  The present article reviews the recent advances in the echocardiographic assessment of left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM). In particular, it highlights the role of novel imaging techniques in promoting our understanding of the pathophysiology of obstruction and discusses the prognostic value of information obtained from exercise echocardiography and the emerging role of image-guidance technologies for interventional relief of obstruction.
  
  
  RESULTS
  The advent of novel echocardiography technologies, such as vector flow mapping, continues to expand our understanding of the exact mechanism of systolic anterior motion leading to dynamic LVOT obstruction by providing new insights into the interaction between pathologic mitral geometry and the left ventricular flow field. New studies provide evidence for the prognostic value of exercise echocardiography in the assessment of patients with HCM. Myocardial contrast perfusion imaging can delineate the anatomy of septal perforator arteries and identify the downstream septal perfusion bed, which is critical for safely guiding the procedure of alcohol septal ablation.
  
  
  CONCLUSIONS
  Echocardiography represents a versatile, continuously evolving, and easily repeatable technique, allowing truly dynamic imaging studies, and is therefore most appropriate to evaluate a dynamic disease condition such as LVOT obstruction in HCM. It provides profound insights into the pathophysiology of LVOT obstruction, information on its clinical impact, and guidance for its relief by interventional strategies.
authors.affiliation: aDepartment of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab bInstitute of Cardiovascular Diseases 'Prof. Dr C. C. Iliescu', Bucharest, Romania cHeart Center, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv University, Israel.
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.forename: Monica
authors.initials: M
authors.lastname: Rosca
authors.forename: Ehud
authors.initials: E
authors.lastname: Schwammenthal
mesh_terms: D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D004452:Echocardiography / Q000379:methods / Q000639:trends; D006801:Humans; D062069:Inventions; D055414:Myocardial Perfusion Imaging / Q000379:methods; D011379:Prognosis; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D017725:Ventricular Pressure