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Number 07-03. HCM with multi-level obstruction

Case from: Mark Westwood, Maite Tome, The Heart Hospital, London, England

Clinical history: A 69 yr-old female, increasing breathlessness.

Past Medical History: Congenital RV infundibular obstruction relieved operatively 50 years (surgeon was Lord Brock)

Cine CMR: LV: 3 level obstruction: 1) Partial systolic anterior motion of the mitral valve with flow streaming. 2) A sub-aortic membrane. 3) Restriction of the non-coronary aortic cusp.

Cine CMR RV: Recurrent RVOT obstruction (after 50 years)

Contrast CMR: RV insertion point LGE only.

Perspective: CMR here helps resolve complex flow obstruction. The patient underwent successful surgery for the second time, after an interval of 50 years.

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