Author + information
- Received October 10, 2012
- Revision received October 23, 2012
- Accepted November 13, 2012
- Published online May 21, 2013.
A 40-year-old woman with hypertrophic cardiomyopathy presented with New York Heart Association functional class III dyspnea and angina despite optimal medical therapy. Left heart catheterization with a high-fidelity, micromanometer-tipped left ventricular (LV) catheter through a transseptal approach was performed to determine location and severity of obstruction.
Aortic and apical LV tracings (LV catheter position, arrow) demonstrated significant obstruction (peak-to-peak gradient 165 mm Hg). The aortic waveform exhibited a “spike and dome” pattern. Aortic and mid-LV measurements revealed a second level of obstruction (gradient 66 mm Hg). Aortic and basal LV evaluation showed no gradient. Two-dimensional and color Doppler echocardiography (A, Online Videos 1 and 2) confirmed two distinct levels of color aliasing, which were not recognized preceding catheterization. Color M-mode (B) further localized the two levels of obstruction within the LV cavity.
The presence of two discrete levels of obstruction guided extended surgical myectomy, with excellent clinical results. Accurate characterization of the location(s) and severity of LV obstruction is crucial when planning septal reduction therapy.
- Received October 10, 2012.
- Revision received October 23, 2012.
- Accepted November 13, 2012.
- American College of Cardiology Foundation