Identification of anomalous anterior papillary muscle insert directly into mitral leaflet in a patient with hypertrophic obstructive cardiomyopathy

2021 ◽  
Author(s):  
Peijian Wei ◽  
Jian Liu ◽  
Weitao Zhuang ◽  
Huiming Guo
Keyword(s):  
Papillary Muscle ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Mitral Leaflet ◽  
Anterior Papillary Muscle

scholarly journals Muscular Mitral Chord Contribution to Left Ventricular Outflow Tract Obstruction in HOCM

2019 ◽  
Vol 08 (01) ◽  
pp. e18-e19
Author(s):  
Olayinka Ogunmuyiwa ◽  
Philipp Rellecke ◽  
Artur Lichtenberg ◽  
Alexander Assmann
Keyword(s):  
Papillary Muscle ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Systolic Anterior Motion ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Septal Myectomy ◽  
Left Ventricular Outflow

AbstractPapillary muscle anomaly with a muscular chord directly attached to the anterior mitral leaflet is a rare mitral valve disease. A 62-year-old man with systolic anterior motion of the anterior mitral leaflet and hypertrophic obstructive cardiomyopathy presented to surgical intervention after unsuccessful transcoronary ablation of septal hypertrophy with alcohol. Intraoperative findings revealed a primarily not detected anomalous muscular mitral chord (0.8 × 2.2 cm) connecting the base of the A1 segment to the anterolateral papillary muscle. Resection of this chord and additional septal myectomy treated systolic anterior motion and obstruction of the outflow tract. In spite of the infrequent occurrence, anomalies of the subvalvular apparatus, such as muscular chords, should be ruled out by thorough transesophageal echocardiography imaging before decision on the therapeutical strategy.

scholarly journals Selective Interventricular Septal Radiofrequency Ablation in Patients With Hypertrophic Obstructive Cardiomyopathy: Who Can Benefit?

2021 ◽  
Vol 8 ◽  
Author(s):  
Qiang Liu ◽  
Hangyuan Qiu ◽  
Ruhong Jiang ◽  
Xiaomei Tang ◽  
Wenpu Guo ◽  
...  
Keyword(s):  
Papillary Muscle ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Functional Class ◽  
Mitral Leaflet ◽  
Alcohol Septal Ablation ◽  
Anterior Mitral Leaflet ◽  
Left Ventricular Outflow ◽  
Septal Hypertrophy ◽  
Surgical Myectomy

Introduction: Septal mass reduction is beneficial for hypertrophic obstructive cardiomyopathy (HOCM) patients with severe left ventricular outflow (LVOT) gradient and symptoms, with surgical myectomy or alcohol septal ablation (ASA) currently recommended in selected patients. Radiofrequency (RF) ablation of hypertrophied septum has been published as a novel method to alleviate LVOT obstruction in small populations. This study aims to investigate factors influencing clinical outcomes of radiofrequency septum ablation.Methods and Results: In this study, 20 patients with HOCM who underwent endocardial ablation were included. Echocardiography and cardiac MRI (CMR) data was collected and analyzed pre- and (or) post- procedure. Nineteen patients underwent ablation successfully, while ablation was aborted in one patient with prior RBBB due to transient complete atrioventricular block (AVB). After 6 months of follow-up, NYHA heart functional class improved from III (2 - 3) to II (1 - 2) (p < 0.001), and resting LVOT gradient was significantly reduced (87.6 ± 29.5 mmHg vs. 48.1 ± 29.7, p < 0.001). LVOT gradient reduction was significantly higher in patients with limited basal septal hypertrophy (60.9 ± 8.3 vs. 27.9 ± 7.1, p = 0.01), shorter anterior mitral leaflet (56.1 ± 6.4 vs. 20.4 ± 5.0, p < 0.01), and normally positioned papillary muscle (36.9 ± 7.1 vs. 75.0 ± 6.3, p < 0.05).Conclusions: Endocardial septal ablation appears to be a safe and effective procedure for alleviating LVOT gradient in patients with HOCM, especially in those with limited basal septal hypertrophy, shorter anterior mitral leaflet, and normal positioned papillary muscle.

Enhanced Regional Deformation at the Anterior Papillary Muscle Insertion Site After Chordal Transsection

Circulation ◽  
1996 ◽  
Vol 93 (3) ◽  
pp. 585-593 ◽  
Author(s):  
Yasuo Takayama ◽  
Jeffrey W. Holmes ◽  
Ian LeGrice ◽  
James W. Covell
Keyword(s):  
Papillary Muscle ◽  
Insertion Site ◽  
Regional Deformation ◽  
Muscle Insertion ◽  
Anterior Papillary Muscle

Vasomotor properties of porcine endocardial and epicardial microvessels

1992 ◽  
Vol 262 (4) ◽  
pp. H1143-H1148 ◽  
Author(s):  
J. E. Quillen ◽  
D. G. Harrison
Keyword(s):  
Myocardial Perfusion ◽  
Papillary Muscle ◽  
Vasodilator Agents ◽  
Cyclic Monophosphate ◽  
Ly 83583 ◽  
Anterior Papillary Muscle

We sought to compare the sensitivity of endocardial and epicardial microvessels to several important neurohumoral substances. Porcine endocardial microvessels (86-200 microns diam) from the anterior papillary muscle and epicardial microvessels of similar size from the left anterior descending distribution were studied in a pressurized state using an in vitro microvessel-imaging apparatus. Endothelium-dependent relaxations to bradykinin, ADP, A23187, and to the endothelium-independent vasodilator nitroprusside were identical between endocardial and epicardial microvessels. In contrast, the sensitivity of endocardial microvessels to adenosine was substantially greater than that of epicardial microvessels (ED50s of -6.59 +/- 0.05 vs. -5.66 +/- 0.11, P less than 0.001, endocardial vs. epicardial, respectively), although adenosine caused 100% relaxation of both groups of vessels at the highest concentrations. Adenosine vasorelaxation was not affected by inhibition of cyclooxygenase by indomethacin (1 microM) or depletion of guanosine 3',5'-cyclic monophosphate by LY 83583 (1 microM). Forskolin dilated both endocardial and epicardial vessels completely but was more potent in endocardial vessels. These data show that endocardial and epicardial microvessels exhibit similar sensitivity to most vasodilator agents. Endocardial microvessels, however, are more sensitive to both adenosine and forskolin. The enhanced responsiveness to adenosine may be related to adenosine 3',5'-cyclic monophosphate-mediated mechanisms and may have important implications regarding regulation of myocardial perfusion in deeper subendocardial layers.

Depressed regional deformation near anterior papillary muscle

1995 ◽  
Vol 269 (1) ◽  
pp. H262-H270 ◽  
Author(s):  
J. W. Holmes ◽  
Y. Takayama ◽  
I. LeGrice ◽  
J. W. Covell
Keyword(s):  
Papillary Muscle ◽  
Insertion Site ◽  
Three Dimensional ◽  
Left Ventricular ◽  
Wall Thickening ◽  
Regional Deformation ◽  
Myocardial Wall ◽  
Muscle Insertion ◽  
Region Data ◽  
Anterior Papillary Muscle

The role of the papillary muscle in left ventricular function has received new attention. We hypothesized that regional mechanics of the left ventricular wall near the anterior papillary muscle are influenced by the papillary muscle insertion. We therefore studied three-dimensional regional mechanics in and near the anterior papillary muscle in anesthetized, open-chest dogs, using implanted radiopaque markers and biplane cineradiography. In seven dogs, deformation differed little between an anterior papillary muscle insertion site (PMA) and a more basal site (PMB) overlying the anterior papillary muscle. However, local shortening and wall thickening were depressed in both locations relative to anterior free wall sites (FWA, FWB) studied in five additional dogs. A distinct structural border was observed at the junction between the myocardial wall and anterior papillary muscle, which may preclude the use of homogeneous strain in that region. Data from within the anterior papillary muscle indicated that uniaxial measurements in the papillary muscle are extremely sensitive to the orientation of the measurement axis, possibly explaining the variety of papillary muscle shortening patterns reported by previous investigators.

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