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Open Access Highly Accessed Case report

Solitary accessory and papillary muscle hypertrophy manifested as dynamic mid-wall obstruction and symptomatic heart failure: diagnostic feasibility by multi-modality imaging

Kuo-Tzu Sung1, Chun-Ho Yun23, Charles Jia-Yin Hou13 and Chung-Lieh Hung134*

Author Affiliations

1 Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan

2 Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan

3 Department of Medicine, Mackay Medical College, and Mackay Medicine, Nursing and Management College, Taipei, Taiwan

4 Cardiovascular Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei, Taiwan

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BMC Cardiovascular Disorders 2014, 14:34  doi:10.1186/1471-2261-14-34

Published: 10 March 2014

Abstract

Background

Solitary papillary muscle (PM) hypertrophy is an unique type of hypertrophic cardiomyopathy (HCM), which is characterized by predominant papillary muscle hypertrophy sparing the rest of other left ventricular segments. It has recently drawn our attention about the mechanism of left ventricular mid-cavity obstruction and the influence of pressure gradient in the left ventricular outflow tract (LVOT), thus carries clinical importance.

Case presentation

We reported a symptomatic, 83-year-old woman who presented with dynamic, high resting left ventricle (LV) mid-wall gradient without obvious septal hypertrophy or systolic anterior motion (SAM). Subsequent real-time (RT) three-dimensional echocardiography (3DE) and cardiac magnetic resonance imaging (MRI) demonstrated large, hypertrophic accessory papillary muscles squeezing mid-cavity of left ventricle producing dynamic pressure gradient during systole in the absence of left ventricular wall anomalies.

Conclusion

We proposed that combined use of echocardiography particularly RT-3DE and cardiac magnetic resonance imaging (MRI) can accurately identify this specific type of hypertrophic cardiomyopathy without remarkable traditional features.

Keywords:
Solitary papillary muscle hypertrophy; LVOT obstruction; Hypertrophic cardiomyopathy