Yonsei Med J.  2007 Oct;48(5):879-882. 10.3349/ymj.2007.48.5.879.

Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy Associated with an Apical Aneurysm: Evaluation of Possible Causes of Aneurysm Formation

• Sato Y
• Matsumoto
• Matsuo S
• Yoda S
• Tani S
• Kasamaki Y
• Takayama T
• Kunimoto S
• Saito S

• KMID: 1122630
• DOI: http://doi.org/10.3349/ymj.2007.48.5.879

Abstract

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.

Keyword

Mid-ventricular obstructive hypertrophic cardiomyopathy; magnetic resonance imaging

MeSH Terms

Cardiomyopathy, Hypertrophic/complications/*diagnosis
Coronary Angiography
Echocardiography, Doppler
Heart Aneurysm/*diagnosis/etiology
Humans
Hypertrophy, Left Ventricular/complications/*diagnosis
Magnetic Resonance Imaging, Cine
Male
Middle Aged
Myocardial Ischemia/complications/diagnosis