A Experience of Surgical Treatment for Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy with Apical Ventricular Aneurysm / 日本心臓血管外科学会雑誌

Mid-ventricular obstructive hypertrophic cardiomyopathy is rare and often complicated by apical ventricular aneurysm, which can cause life-threatening ventricular arrhythmias. A 76-year-old male patient came to our hospital because of an electrocardiogram abnormality (giant T-wave inversion). Transthoracic echocardiography showed myocardial hypertrophy at the level of the papillary muscles, apical thinning, and aneurysm formation. The patient was diagnosed with mid-ventricular obstructive hypertrophic cardiomyopathy with apical ventricular aneurysm. During follow-up, the patient developed exertional dyspnea, and nonsustained ventricular tachycardia was noted on Holter monitoring. Therefore, we opted for surgical treatment. The patient was placed on cardiopulmonary bypass and treated with apical aneurysmectomy, followed by myectomy with a trans-apical approach. Postoperative echocardiography showed an increased left ventricular end-diastolic volume. The patient no longer had difficulty breathing and did not develop postoperative ventricular arrythmia. He has been uneventful six months after surgery. We considered surgical treatment was effective in treating arrhythmias and heart failure.

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

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.

Aneurysmectomy of Mid-Ventricular Obstructive Hypertrophic Cardiomyopathy with an Apical Ventricular Aneurysm / 日本心臓血管外科学会雑誌

A typical feature of mid-ventricular obstructive hypertrophic cardiomyopathy (MVO-HCM), is obvious hypertrophy of the mid-ventricular muscle and ventricle with transformation into the shape of an hourglass. We report a 60-year-old woman who had been given a diagnosis of apical type hypertrophic cardiomyopathy 12 years previously, but it changed to MVO-HCM with apical left ventricular aneurysm. We considered the impending rupture of the aneurysm because its wall was thin and pericardial effusion was detected by UCG (ultrasonic cardiograph). Urgent surgery was performed consisting of ventricular aneurysmectomy and patch reconstruction. After the surgery, a pseudoaneurysm was found in cardiac apex, so we performed surgery again. A residual shunt in the trabeculation caused the pseudoaneurysm, but its origin was not clear. She has been fine for 18 months without complications such as recurrence of aneurysm, ventricular arrhythmia or left ventricular dysfunction since the last surgery.