Apical hypertrophic cardiomyopathy: diagnosis, medical and surgical treatment

Fig. 1. A – Transthoracic echocardiography, four-chamber view. Patient with AHCM. Note the increased thickness of the apex of the left ventricle (arrow). B – Transthoracic echocardiography, fourchamber view. Contrast echocardiography (SonoVue). The same patient as in Figure 1 A. Note the opacification of the left ventricle revealing typical silhouette of “ace of spades”. C – Transthoracic echocardiography, four-chamber view. Patient with AHCM. Contrast echocardiography (SonoVue). Note the opacification of the left ventricle revealing the presence of apical aneurysm (arrow) LA – left atrium, LV – left ventricle, RA – right atrium, RV – right ventricle.

Fig. 2. A – Cardiac magnetic resonance, four-chamber view. Patient with AHCM. Note isolated apical hypertrophy (arrow) with apical aneurysm (dashed arrow). B – Cardiac magnetic resonance, four-chamber view. Patient with AHCM. Note apical fibrosis as revealed with gadolinium late enhancement (arrow) LA – left atrium, LV – left ventricle, RA – right atrium, RV – right ventricle.

Fig. 3. Left ventricular angiogram in patient with known AHCM. Note the typical shape of the left ventricle with “ace of spades” silhouette Ao – ascending aorta, LV – left ventricle.

Fig. 4. A – Transoesophageal echocardiography, X-plane view. Patient with AHCM. Note the increased thickness of the apex and small end-diastolic volume of the left ventricle. B – Transoesophageal echocardiography, three-chamber view. The same patient as in Figure 4 A. Note the increased thickness of the apex and small end-diastolic volume of the left ventricle Ao – ascending aorta, LA – left atrium, LV – left ventricle.

Fig. 5. A – Intraoperative picture of opened apex of the left ventricle. Note thickened apex of the left ventricle (arrow). B – Intraoperative picture after apical myectomy. Note presence of Teflon patch (arrow) closing apex of the left ventricle

Fig. 6. A – Transoesophageal echocardiography, three-chamber view. The same patient as in Figures 4 A, B after myectomy. Note the increased end-diastolic volume of the left ventricle. B – Transoesophageal echocardiography, two-chamber view. The same patient as in Figures 4 A, B after myectomy. Note the increased end-diastolic volume of the left ventricle Ao – ascending aorta, LA – left atrium, LV – left ventricle.

Fig. 7. A – Transthoracic echocardiography, four-chamber view. The same patient as in Figures 4 A, B 12 months after myectomy. Note the increased end-diastolic volume of the left ventricle. B – Transthoracic echocardiography, two-chamber view. The same patient as in Figures 4 A, B 12 months after myectomy. Note the increased end-diastolic volume of the left ventricle LA – left atrium, LV – left ventricle, RA – right atrium, RV – right ventricle.