An Unusual Presentation of Apical Hypertrophic Cardiomyopathy in an Orthotopic Heart Transplant Recipient

Figures

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  Figure 1. Evolution of ECG left ventricular hypertrophy repolarization changes The first ECG depolarization abnormalities suggestive of hypertrophic disease were seen around 10 years post-transplant. By 16 years post-transplant, the patient exhibited voltage criteria for Left ventricular hypertrophy and deep T-wave inversions typical for ApHCM, which worsened as the condition progressed. Patients with ApHCM are associated with marked T-wave inversions in the precordial leads (red arrows). Inverted T-waves were also observed in the inferior (blue arrows) and high lateral leads (green arrows)

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  Figure 2. Echocardiographic evaluation 22 years after the OHT TTE follow-up 22 years after the OHT with severe ApHCM demonstrated in (A-B) PLAX, (C-D) parasternal short axis at the level of the papillary muscles, and (E-F) apical 4 chamber view with color flow Doppler. (G-H) The contrast-enhanced TTE in apical 2 chamber view shows severe apical left ventricular hypertrophy with the classical “spade-shaped” ventricular cavity in diastole, with mid-cavity obliteration during systole, and an apical aneurysm

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  Figure 3. Echocardiographic evaluation 22 years after the OHT demonstrating the midventricular cavity obliteration (A-C) and strain polar plot (D) showing loss of longitudinal strain apically

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  Figure 4. cMRI revealing ApHCM with apical aneurysm formation Severe ApHCM in long‐axis two‐chamber views (A-B) and long‐axis four‐chamber views (C-D) with mid-ventricular obstruction and ventricular cavity obliteration during systole. Short axis views (E-G) demonstrate the sparing of basal segments with apical hypertrophy, predominantly affecting mid and apical segments with a small apical aneurysm (G)