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Images and Case Reports in Heart Failure

Resting Systolic Anterior Motion of Mitral Valve Apparatus

Association With Apical Ballooning Syndrome

Andrew C.Y. To, MBChB; Ali A. Khan, MBBS; Patrick Kay, PhD and Andrew J. Kerr, MBChB

From the Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.

Correspondence to Dr Andrew To, Department of Cardiology, Middlemore Hospital, Hospital Rd, Otahuhu, Auckland 1640, New Zealand. E-mail andrewcyto@gmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Two patients, a 67-year-old man (patient 1) and a 72-year-old woman (patient 2), presented with sudden onset chest pain after significant emotional stress. Patient 2 also had acute pulmonary edema on presentation. An ECG showed ST elevation in the precordial leads, and the patient’s cardiac enzymes were elevated. A coronary angiogram showed no flow-limiting lesions. A left ventriculogram demonstrated the typical pattern of apical ballooning syndrome with basal hypercontractility and apical akinesis (Figure, A, and Movie I). The diagnosis of apical ballooning syndrome was made in both cases.

View larger version (52K):   Figure. A, Left ventriculogram of patient 1 showing the typical pattern of apical ballooning syndrome. Transthoracic echocardiogram in patient 1 at admission showing SAM of the mitral valve with LVOT obstruction (B) and severe MR (C). D, Continuous-wave Doppler profile outlining the degree of LVOT obstruction. The recovery echocardiogram 8 weeks later showed nonobstructive SAM (E) and resolution of the MR (F).

 
A transthoracic echocardiogram in patient 1 showed hyperdynamic basal segments and mild upper septal hypertrophy with systolic anterior motion (SAM) of the mitral valve resulting in moderate left ventricular outflow track (LVOT) obstruction (LVOT velocity, 3.7 m/s) (Figure, B and D). There was severe functional mitral regurgitation (MR) (Figure, C). Patient 2 had similar test results, with SAM of the mitral valve, moderate LVOT obstruction of 3.1 m/s and severe MR (Movies II and III).

Repeat echocardiograms at 2 to 4 months after initial presentation showed normal LV function and resolution of the LV . . . [Full Text of this Article]