Case of the week 0707: HCM with LVOT obstruction by CMR

1
Case of the week 07-07 HCM with LVOT
obstruction by CMR
Clinical 62 year old ? with HCM with obstruction
referred for alcohol septal ablation (ASA)
refractory symptoms of angina and dyspnea. This
was a baseline study done prior to ASA.
Examination Harsh apical 3/6 holosystolic
murmur, accentuated with Valsalva maneuver. CMR
Asymmetric septal hypertrophy, systolic anterior
motion of the anterior leaflet of the mitral
valve and moderate Mitral Regurgiation. No
resting perfusion defect or late gadolinium
enhancement.
Echo Complements the CMR and shows high
frequency events (aortic valve fluttering and
premature closure) and the SAM. Resting gradient
was 52mmHg, 104 with provocation. Perspective
CMR can follow the effect of ASA in reducing ASH,
localizing the MI, and tracking changes in the
LV, LVOTO and MR. Reference Valeti et al.
JACC 200749350-7.
Karen Smith, Carsten Schmalfuss, Roger Shifrin,
Norbert Wilke, Gary Cooper, Departments of
Radiology and Medicine, University of Florida,
Gainesville, Florida, USA.