A unique presentation of systolic anterior motion of the mitral valve in a patient with obstructive hypertrophic cardiomyopathy and recurrent syncope: a case report

Figures

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  Figure 1. Transthoracic 2D echocardiogram: (A) the parasternal long-axis view shows marked thickening of the basal and mid-segments of the ventricular septum, with the anterior mitral valve leaflet moving towards the ventricular septum (arrow). Left atrial enlargement is evident. (B) In the same view, colour Doppler imaging reveals aliasing flow in the left ventricular outflow tract and mitral regurgitation (arrow) during systole. (C) Immediate post-procedure imaging in the same view shows improvements in systolic anterior mitral valve motion. (D) The parasternal long-axis view with colour Doppler demonstrates restored laminar flow in the left ventricular outflow tract after the procedure.

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  Figure 2. Electrocardiogram: (A) before the procedure, the electrocardiogram showed normal sinus rhythm with ST-segment depression in leads I, II, III, aVF, and V4–V6. (B) During the patient’s shock period, the electrocardiogram revealed a significant ST-segment depressed, with a maximum of 0.7 mV in lead II. STv1,2 elevated 0.3 mv.

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  Figure 3. Transthoracic 2D echocardiogram during shock and recovery periods: (A) in the parasternal long-axis view, there is notable thickening of the ventricular septal base and middle segments, with the midpoint of the mitral anterior leaflet moving closely to the ventricular septum (distance < 2 mm). Additionally, left atrial enlargement is also noted. (B) In the same view, colour Doppler imaging shows a small region of aliasing flow in the LVOT and mitral regurgitation (arrow) during systole. (C) Ten minutes after the shock, the same view demonstrates improvement in systolic anterior motion of the mitral valve. (D) At the same time as (C), the parasternal long-axis view with colour Doppler shows restored laminar flow in the left ventricular outflow tract and a reduction of mitral regurgitation to a mild degree.

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  Figure 4. Transthoracic 2D echocardiogram 3 months post-procedure: (A) the resolution of systolic anterior mitral valve motion is evident. (B) Mitral regurgitation has completely resolved.