PMC9979926_01
Transgastric midpapillary short axis at view at end-systole showing a severely concentric hypertrophied left ventricle.
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HOCM, systolic anterior motion (SAM) of the mitral valve leaflet, and severe concentric left ventricular hypertrophy (Figure 1) with preserved systolic function were evident on intraoperative transesophageal echocardiography. SAM was from a redundant posterior mitral leaflet moving across the left ventricular outflow tract (LVOT) during systole (Figure 2A and Video S1).
A) Midesophageal 5-chamber view at end-systole showing significant myocardial hypertrophy at the level of the LVOT, and the mitral valve posterior leaflet being drawn into the LVOT. B) Midesophageal 5-chamber view at end-systole with color Doppler showing turbulent flow through a constricted LVOT. LA = left atrium, LV = left ventricle, RV, right ventricle, LVOT = left ventricular outflow tract, IVS = interventricular septum, MV = mitral valve.
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SAM was from a redundant posterior mitral leaflet moving across the left ventricular outflow tract (LVOT) during systole (Figure 2A and Video S1). Intraoperative echocardiogram found an LVOT gradient of 24 mm Hg, and colour Doppler across the LVOT demonstrated flow acceleration and turbulence associated with dynamic outflow obstruction (Figure 2B).