Document Detail

Hypertrophic obstructive cardiomyopathy with abnormalities of the mitral valve complex.
MedLine Citation:
PMID:  9044078     Owner:  NLM     Status:  MEDLINE    
The mechanism of obstruction of the left ventricular outflow tract (LVOT) in hypertrophic obstructive cardiomyopathy (HOCM) is mainly due to dynamic systolic anterior motion (SAM) of the mitral valve. We report a case of HOCM with mitral regurgitation (MR) associated with complicated abnormalities of the mitral apparatus which contributed to a high pressure gradient through the LVOT. A small, 53-year-old woman was admitted for chest pain and palpitation. Examinations revealed asymmetric septal hypertrophy of the left ventricle, MR, SAM of the mitral valve and a high pressure gradient (108 mmHg) through the LVOT. Operative findings revealed an abnormally hypertrophied interventricular septum, an extensively thickened and enlarged anterior mitral leaflet (AML), malposition of the origin of the anterior papillary muscle arising closer to the aortic annulus than normal, and its direct insertion into the AML without any distinguishable chordae tendineae. The hypertrophied septum and the large and protruding AML appeared to obstruct the LVOT, resulting in a loss of subaortic clearance that was recovered after mitral valve replacement and myectomy. Pathology of the papillary muscle was characteristic of HOCM, showing disorganization and disarray of myocardial fibers, bizarre-shaped nuclei, and intercellular fibrosis, while those of the mitral leaflets negated both rheumatic changes and endocarditis.
A Ohkado; M Kitamura; M Hachida; T Nishinaka; N Hanayama; W Sato; H Koyanagi
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  6     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  1997 Jan 
Date Detail:
Created Date:  1997-05-02     Completed Date:  1997-05-02     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  60-2     Citation Subset:  IM    
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.
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MeSH Terms
Cardiomyopathy, Hypertrophic / complications*
Middle Aged
Mitral Valve / abnormalities*,  physiopathology
Mitral Valve Insufficiency / complications*
Papillary Muscles / abnormalities,  pathology
Ventricular Outflow Obstruction / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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