Mid-ventricular hypertrophic cardiomyopathy with apical aneurysm: a multimodality imaging case report

Figures

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  Figure 1. 12-lead ECG revealing sinus rhythm with a heart rate of 63 beats/min. Sokolow-Lyon Criteria (S in V1 + R in V5 or V6) of 37 mm confirms left ventricular hypertrophy. Negative T waves measuring up to 5 mm in amplitude are present from V2 to V6, DI and aVL (red arrow). Premature ventricular contraction is observed (blue arrow).

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  Figure 2. Four-chamber transthoracic echocardiographic view with color Doppler, showing an apical aneurysm (arrow). Abbreviations: An, Aneurysm; LA, Left atrium; RA, Right atrium; RV, Right ventricle.

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  Figure 3. A) Parasternal long-axis view showing redundant chordae tendineae (arrow). B) Parasternal long-axis view with color Doppler, demonstrating the absence of subaortic obstruction (Laminar flow). C) Apical five-chamber view with color and continuous-wave Doppler, showing no evidence of subaortic obstruction. D) Four-chamber view with color Doppler, revealing turbulence in the apical portion of the left ventricle. E) Four-chamber view showing mild mitral regurgitation. F) Four-chamber view with color and continuous-wave Doppler demonstrating apical obstruction with a maximum gradient of 42 mmHg, partially contaminated by mitral regurgitation flow.

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  Figure 4. Cardiac magnetic resonance with four-chamber, mid-ventricular and apical views during diastole (above) and systole (below) showing mid-ventricular hypertrophy of 15.3 mm (yellow arrows) with apical aneurysm (red asterisk). Increased trabeculations can be seen in anterolateral, basal, medial, and lateral apical segments.

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  Figure 5. Late gadolinium enhancement resonance with two, three, and four-chamber views (above) and basal to apical views (below) showing subendocardial late gadolinium enhancement in mid-apical segments less than 15% of the total ventricular mass (red arrows).