Journal of the American Society of Echocardiography
Original articleAsymmetry of Systolic Anterior Motion of the Mitral Valve in Patients with Hypertrophic Obstructive Cardiomyopathy: A Real-time Three-dimensional Echocardiographic Study
Section snippets
Participants
In all, 39 patients with HOCM (age 43 ± 11 years, 13 women) who had asymmetric septal hypertrophy and underwent RT3DE were enrolled (Table), including 5 patients in whom intraoperative epicardial RT3DE images were obtained for better image quality. Inclusion criteria were: (1) definite SAM; (2) structurally normal mitral valve; and (3) RT3DE images clear enough to analyze. Exclusion criteria were: (1) irregular heart rhythm such as atrial fibrillation; and (2) clinical and echocardiographic
Asymmetry of SAM
Aα measured in the medial and central planes was significantly smaller than that in the lateral plane (45 ± 9, 47 ± 8, and 50 ± 8 degrees, respectively; P < .001) (Figure 3, A). Aα in the medial plane was significantly smaller than that in the central plane (P < .005). Bα in the medial and central plane was also significantly smaller than that in the lateral plane (75 ± 19, 87 ± 16, and 112 ± 16 degrees, respectively; P < .001) (Figure 3, B). Bα in the medial plane was significantly smaller
Discussion
We have demonstrated an asymmetric configuration of SAM in patients with HOCM by the use of RT3DE; SAM develops predominantly in the medial side, resulting in laterally located narrow LVOT opening (Figure 5). More acute-angled SAM was shown in the medial side than lateral side, and larger DS was found in the lateral side than medial side.
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Supported by the Postdoctoral Fellowship Program of Korea Science and Engineering Foundation.
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Dr Song is now affiliated with Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.