Case of the Week   ·   Case Archive   ·   Submit a Case

Number 07-07: HCM with LVOT obstruction by CMR

Karen Smith, Carsten Schmalfuss, Roger Shifrin, Norbert Wilke, Gary Cooper, Departments of Radiology and Medicine, University of Florida, Gainesville, Florida, USA.

Clinical: 62 year old man 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.

Scanner: Siemens Sonata 1.5T