Original article
Morphological Determinants of Subaortic Stenosis in Hypertrophic Cardiomyopathy: Insights From Real-Time 3-Dimensional Echocardiography

https://doi.org/10.1016/j.echo.2004.12.007Get rights and content

Real-time 3-dimensional echocardiography allows a comprehensive evaluation of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy. The anterior segment of the anterior mitral leaflet is essential in the development of the LVOT pressure gradient.

Section snippets

Methods

We evaluated 28 patients diagnosed with hypertrophic cardiomyopathy at our institution. All of them demonstrated an asymmetric septal pattern. Two patients were in New York Heart Association functional class II, and the remainder were asymptomatic.

Two-dimensional (2-D) echocardiography and continuous wave Doppler was performed with a Sonos 7500 (Phillips, Andover, Mass) using an S3 probe. Left ventricle, left atrium, and wall diameters were taken from the standard paraesternal long-axis view.

Results

Clinical and 2-D echocardiographic characteristics are displayed in Table 1. Eleven of the patients were men (40%), and mean patient age was 64 ± 15 years (range, 27–84 years). Heart rate was 50–70/min in all patients, because all were receiving beta-blockers or calcium channel blockers. Significant dynamic LVOT obstruction > 30 mm Hg (systolic pressure gradient of 61 ± 21 mm Hg, 40–108 mm Hg) was present in 14 patients. Valsalva’s maneuver augmented pressure gradients in those who already had

Discussion

The presence and magnitude of the LVOT gradient have been related to several morphological and hemodynamic factors. The aim of the present study was to define the importance of the extension of the anterior mitral leaflet moving toward the septum. Only the anterior segment was responsible for the LVOT obstruction. It seems that once the obstruction is been created by the anterior segment (the closest to the LVOT and septum), SAM of the other segments does not exacerbate the obstruction at this

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