INTRODUCTION:Mitral valve abnormalities?in hypertrophic cardiomyopathy (HCM) are becoming increasingly well defined, and their role in intra-ventricular obstruction is well defined. The aim of this study was to evaluate mitral valve abnormalities?in patients with HCM. PATIENTS AND METHODS: We conducted a descriptive cross-sectional study from May 1 to July 1, 2022 in the Cardiology Department of Aristide Le Dantec Hospital. All patients with HCM aged at least 18 years old were included. The parameters studied concerned mainly the mitral valvular apparatus (papillary muscles abnormalities, leaflet length, mitral insufficiency). RESULTS: A total of 10 patients were included. Mean age was 58.3. On Doppler echocardiography, mean interventricular septal thickness was 20.6 mm. The mean maximum intra-ventricular gradient was 21.06 mmHg. Two patients had significant intraventricular obstruction. The mean length of the anterior mitral valve leaflet was 28.7 ± 3.55 mm, with extremes of 22 and 33 mm. The posterior mitral leaflet averaged 14.8 ± 3.16 mm. Nine (9) out of 10 patients had an elongated anterior valve leaflet. Elongation of the posterior leaflet was noted in 6 patients. With regard to papillary muscle position, 6 patients had an anterolateral ascending pillary muscle. These patients had a mean intra-ventricular gradient of 25 mmHg, compared with 16.5 mmHg in the others cases. We found no direct insertion on the mitral valve. Mitral insufficiency was noted in 9 patients, including 5 with mild insufficiency and 4 with moderate one. CONCLUSION: Mitral valve abnormalities?in HCM appear to be frequent. They should be analyzed for a better diagnostic and therapeutic approach.
References
[1]
Elliott, P., Anastasakis, A., Borger, M.A., et al. (2014) ESC Guidelines on Diagnosis and Management of Hypertrophic Cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). European Heart Journal, 35, 2733-2779.
https://doi.org/10.1093/eurheartj/ehu284
[2]
Gersh, B.J., Maron, B.J., Bonow, R.O., et al. (2011) 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 58, e212-260.
Brock, R. (1957) Functional Obstruction of the Left Ventricle; Acquired Aortic Subvalvar Stenosis. Guy’s Hospital Reports, 106, 221-238.
[5]
Carasso, S., Yang, H., Woo, A., et al. (2008) Systolic Myocardial Mechanics in Hypertrophic Cardiomyopathy: Novel Concepts and Implications for Clinical Status. Journal of the American Society of Echocardiography, 21, 675-683.
https://doi.org/10.1016/j.echo.2007.10.021
[6]
Austin, B.A., Kwon, D.H., Smedira, N.G., et al. (2009) Abnormally Thickened Papillary Muscle Resulting in Dynamic Left Ventricular Outflow Tract Obstruction: An Unusual Presentation of Hypertrophic Cardiomyopathy. Journal of the American Society of Echocardiography, 22, 105.e5-e6.
https://doi.org/10.1016/j.echo.2008.10.022
[7]
Fischer, G.W., Anyanwu, A.C. and Adams, D.H. (2009) Intraoperative Classification of Mitral Valve Dysfunction: The Role of the Anesthesiologist in Mitral Valve Reconstruction. Journal of Cardiothoracic and Vascular Anesthesia, 23, 531-543.
https://doi.org/10.1053/j.jvca.2009.03.002
[8]
Canepa, M., Fumagalli, C., Tini, G., et al. (2020) Temporal Trend of Age at Diagnosis in Hypertrophic Cardiomyopathy: An Analysis of the International Sarcomeric Human Cardiomyopathy Registry. Circulation: Heart Failure, 13, e007230.
https://doi.org/10.1161/CIRCHEARTFAILURE.120.007230
[9]
Olivotto, I., Maron, M.S., Adabag, A.S., et al. (2005) Gender-Related Differences in the Clinical Presentation and Outcome of Hypertrophic Cardiomyopathy. Journal of the American College of Cardiology, 46, 480-487.
https://doi.org/10.1016/j.jacc.2005.04.043
[10]
Maron, E.E., Janabi, M. and Kaushik, R. (2006) Clinical and Echocardiographic Study of Hypertrophic Cardiomyopathy in Tanzania. Tropical Doctor, 36, 225-227.
https://doi.org/10.1258/004947506778604904
[11]
Maron, M.S., Olivotto, I., Harrigan, C., et al. (2011) Mitral Valve Abnormalities Identified by Cardiovascular Magnetic Resonance Represent a Primary Phenotypic Expression of Hypertrophic Cardiomyopathy. Circulation, 124, 40-47.
https://doi.org/10.1161/CIRCULATIONAHA.110.985812
[12]
Klues, H.G., Proschan, M.A., Dollar, A.L., et al. (1993) Echocardiographic Assessment of Mitral Valve Size in Obstructive Hypertrophic Cardiomyopathy. Anatomic validation from Mitral Valve Specimen. Circulation, 88, 548-555.
https://doi.org/10.1161/01.CIR.88.2.548
[13]
Hagège, A.A., Dubourg, O., Desnos, M., et al. (1998) Familial Hypertrophic Cardiomyopathy. Cardiac Ultrasonic Abnormalities in Genetically Affected Subjects without Echocardiographic Evidence of Left Ventricular Hypertrophy. European Heart Journal, 19, 490-499. https://doi.org/10.1053/euhj.1997.0735
[14]
Judge, D.P., Neamatalla, H., Norris, R.A., et al. (2015) Targeted Mybpc3 Knock-Out Mice with Cardiac Hypertrophy Exhibit Structural Mitral Valve Abnormalities. Journal of Cardiovascular Development and Disease, 2, 48-65.
https://doi.org/10.3390/jcdd2020048
[15]
Klues, H.G., Maron, B.J., Dolla, A.L., et al. (1992) Diversity of Structural Mitral Valve Alterations in Hypertrophic Cardiomyopathy. Circulation, 85, 1651-1660.
https://doi.org/10.1161/01.CIR.85.5.1651
[16]
Klues, H.G., Roberts, W.C. and Maron, B.J. (1991) Anomalous Insertion of Papillary Muscle Directly into Anterior Mitral Leaflet in Hypertrophic Cardiomyopathy. Significance in Producing Left Ventricular Outflow Obstruction. Circulation, 84, 1188-1197. https://doi.org/10.1161/01.CIR.84.3.1188