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Table of Contents
LETTER TO THE EDITOR  
Year : 2020  |  Volume : 23  |  Issue : 1  |  Page : 109-110
Systolic anterior motion of the mitral chordae tendineae as a possible etiology for a significant left ventricular outflow tract obstruction


Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran

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Date of Submission05-Feb-2019
Date of Decision20-May-2019
Date of Acceptance25-May-2019
Date of Web Publication07-Jan-2020
 

How to cite this article:
Hosseinsabet A, Davarpasand T. Systolic anterior motion of the mitral chordae tendineae as a possible etiology for a significant left ventricular outflow tract obstruction. Ann Card Anaesth 2020;23:109-10

How to cite this URL:
Hosseinsabet A, Davarpasand T. Systolic anterior motion of the mitral chordae tendineae as a possible etiology for a significant left ventricular outflow tract obstruction. Ann Card Anaesth [serial online] 2020 [cited 2020 Apr 5];23:109-10. Available from: http://www.annals.in/text.asp?2020/23/1/109/275293




Sir,

A 62-year-old obese woman with a history of atypical chest pain and cardiac murmurs was referred to our echocardiography laboratory for further evaluations. She had a history of controlled hypertension of 5years' duration, for which she was on losartan. In physical examination, a systolic murmur (gradeIII/VI) was auscultated at the left parasternal border. Electrocardiography showed an intraventricular conduction delay; QRS duration was about 100 ms, left axis deviation, and QS pattern in all precordial and inferior leads with secondary ST-T changes. Despite poor echocardiography windows, transthoracic echocardiography revealed that the base and mid segments of the anteroseptal and inferoseptal walls were hypertrophied with a maximal thickness of 15mm and a moderate-to-severe subaortic stenosis with a peak pressure gradient of 57 mmHg. Transesophageal echocardiography showed no aortic valve stenosis, no mitral valve prolapse, trivial mitral regurgitation, and a significant systolic anterior motion of the mitral chordae tendineae [[Figure1] and Videos1-4]. It seems that the systolic anterior motion of the mitral chordae tendineae was the main etiology of the left ventricular tract obstruction.
Figure 1: Systolic anterior motion of the mitral chordae tendineae (arrow) in transesophageal echocardiography [(a) mid-esophageal five-chamber view and (b) mid-esophageal long-axis view of the aortic valve], resulting in left ventricular outflow obstruction in color Doppler study [(c) mid-esophageal five-chamber view and (d) mid-esophageal long-axis view of the aortic valve]. LA, left atrium; LV, left ventricle; AO, ascending aorta

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When we encounter dynamic left ventricular outflow tract, we expect that moderately severe mitral regurgitation would exist, but if the amount of mitral regurgitation is less than expected, mid-cavity obstruction(due to broad base of continuous wave), systolic anterior motion of posterior mitral leaflet, or systolic anterior motion of chordae tendineae as possible cause of dynamic left ventricular obstruction should be considered.[1],[2],[3],[4],[5] Accordingly, such as presented case, cardiologists should bear in mind that the systolic anterior motion of the mitral chordae tendineae can result in a significant left ventricular outflow tract obstruction.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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RakowskiH, HossS, WilliamsLK. Echocardiography in the diagnosis and management of hypertrophic cardiomyopathy. Cardiol Clin 2019;37:11-26.  Back to cited text no. 1
    
2.
ParatoVM, AntoncecchiV, SozziF, MaraziaS, ZitoA, MaielloM, etal. Echocardiographic diagnosis of the different phenotypes of hypertrophic cardiomyopathy. Cardiovasc Ultrasound 2016;14:30.  Back to cited text no. 2
    
3.
DominguezF, González-López E, Padron-BartheL, CaveroMA, Garcia-PaviaP. Role of echocardiography in the diagnosis and management of hypertrophic cardiomyopathy. Heart 2018;104:261-73.  Back to cited text no. 3
    
4.
PatilPV, WiegersSE. Echocardiography for hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2014;57:91-9.  Back to cited text no. 4
    
5.
SherridMV, BalaramS, KimB, AxelL, SwistelDG. The mitral valve in obstructive hypertrophic cardiomyopathy: Atest in context. J Am Coll Cardiol 2016;67:1846-58.  Back to cited text no. 5
    

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Correspondence Address:
Ali Hosseinsabet
Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran
Islamic Republic of Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_20_19

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