New Developments in Hypertrophic Cardiomyopathy

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New Developments in Hypertrophic Cardiomyopathy Robert M. Cooper, MBChB, MRCP, PhD, Claire E. Raphael, MBBS, MRCP, PhD, Max Liebregts, MD, Nandan S. Anavekar, MBBCh, FACC, Josef Veselka, MD, PhD Canadian Journal of Cardiology Volume 33, Issue 10, Pages 1254-1265 (October 2017) DOI: 10.1016/j.cjca.2017.07.007 Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions

Figure 1 Diffusion tensor cardiovascular magnetic resonance images. Sheetlet orientation changes are from blue in diastole to red in systole in normal control subjects. Hypertrophic cardiomyopathy takes a healthy systolic conformation (wall perpendicular sheetlets) but an incomplete diastolic conformation (mix of wall parallel and wall perpendicular sheetlets). Canadian Journal of Cardiology 2017 33, 1254-1265DOI: (10.1016/j.cjca.2017.07.007) Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions

Figure 2 An example of a hypertrophic cardiomyopathy 3-D print used for patient education. Canadian Journal of Cardiology 2017 33, 1254-1265DOI: (10.1016/j.cjca.2017.07.007) Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions

Figure 3 (A) Bifid posterior papillary muscle. (B) Mitral valve (MV) prolapse in hypertrophic cardiomyopathy. (C) Direct insertion of papillary muscle in to the MV. (D) Heavily fractionated papillary muscles—one of the anterior muscles moves into the left ventricular outflow tract in systole, causing obstruction. Canadian Journal of Cardiology 2017 33, 1254-1265DOI: (10.1016/j.cjca.2017.07.007) Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions

Figure 4 Septal reduction. (A) Typical septal hypertrophy with systolic anterior motion (SAM) of the mitral valve (MV). (B) The target for septal reduction. (C) Result after septal reduction. (D) Balanced steady state free precession (bSSFP) cine of hypertrophic cardiomyopathy in systole with SAM of the MV (matching panel A). (E) Late gadolinum enhancement image with high signal intensity (infarct of alcohol septal ablation [ASA]) in the basal septum. (F) Post-ASA bSSFP cine in systole with septal shrinking and widening of the LVOT, no SAM is seen. LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; RV, right ventricle. Canadian Journal of Cardiology 2017 33, 1254-1265DOI: (10.1016/j.cjca.2017.07.007) Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions

Figure 5 Mechanisms of perfusion abnormalities in hypertrophic cardiomyopathy. There are 4 potential contributing mechanisms to development of myocardial ischemia in hypertrophic cardiomyopathy. First-pass myocardial perfusion imaging using cardiac magnetic resonance typically shows a circumferential subendocardial perfusion defect after administration of intravenous adenosine (A). A negative cardiac magnetic resonance perfusion scan is shown in (B) for reference. LVOT, left ventricular outflow tract. Canadian Journal of Cardiology 2017 33, 1254-1265DOI: (10.1016/j.cjca.2017.07.007) Copyright © 2017 Canadian Cardiovascular Society Terms and Conditions