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European Journal of Echocardiography Advance Access published online on July 11, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen197
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Anomalous insertion of the papillary muscle causing left ventricular outflow obstruction: visualization by real-time three-dimensional echocardiography

Hyun Suk Yang, Kwan S. Lee, Hari P. Chaliki, Henry D. Tazelaar, Joan L. Lusk, Krishnaswamy Chandrasekaran* and A. Jamil Tajik

Division of Cardiovascular Diseases, Mayo College of Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA

Received 21 March 2008; accepted after revision 4 June 2008.

* Corresponding author. Tel: +1 480 342 3178.E-mail address: kchandra{at}mayo.edu


  Abstract

Anomalous insertion of the papillary muscle (PM)/chordae tendineae is a rare but important cause of dynamic left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic cardiomyopathy or cardiac amyloidosis. These anomalies are often challenging to diagnose with 2-D Echo, yet accurate diagnosis is critical in determining whether to proceed with an extended septal myectomy instead of a standard septal myectomy for relief. We report two cases of anomalous insertion of the PM causing LVOT obstruction with diagnosis facilitated by real-time 3-D echocardiograms.

Keywords: Papillary muscle; Hypertrophic cardiomyopathy; Amyloidosis


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