Morphological abnormalities in hypertrophic cardiomyopathy - a cardiac mri based study
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Date
2019-12
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SCTIMST
Abstract
Hypertrophic cardiomyopathy (HCM) has a varied clinical course due to its
genotypic and phenotypic heterogeneity. Several autopsy studies have shown
abnormalities of the mitral valve in some HCM patients. Cardiovascular magnetic
resonance (CMR) has become the imaging modality of choice due to its high spatial
resolution, well suited to define the diverse phenotypic expression of this complex
disease.
HCM has been documented to have various mitral valve abnormalities like an
increased length of the leaflets and area, leaflet thickening, impaired mitral leaflet
coaptation, and left ventricular outflow tract obstruction (LVOT) due to the systolic
anterior motion of the mitral leaflets. Cardiovascular magnetic resonance (CMR)
provides an excellent opportunity to assess the papillary muscle (PM) abnormalities like
an increased number and mass, bifidity, hypertrophy, antero-apical displacement and
LGE of the papillary muscle.
Various guidelines recommend surgical myectomy as the preferred modality for
patients with left ventricular outflow tract (LVOT) gradient ≥50 mm Hg who fail to
respond to medications or who experience side effects. Alcohol septal ablation (ASA) in
patients with mitral valve abnormalities results in persistent SAM, gradients, and mitral
regurgitation (MR).