European Journal of Echocardiography 2008 9(1):72-73; doi:10.1016/j.euje.2006.12.003
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org
Myocardial bridge in hypertrophic cardiomyopathy: imaging with color Doppler echocardiography
Mohamad Ali Ostovan* and
Amir Aslani
Cardiology Department, Shiraz University of Medical Sciences, Namazee Hospital, Zand Avenue, Shiraz, P.O. Box 71935-1334, Iran
Received 6 December 2006; accepted after revision 15 December 2006; online publish-ahead-of-print 26 February 2007.
* Corresponding author. Tel: + 917 313 1320; fax: +98 711 6279733. E-mail address: dzintern{at}yahoo.com
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Abstract
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A 50-year-old man presented with chest pain and recurrent episodes
of syncope. Physical examination revealed a loud systolic murmur
at the left sternal border with accentuation in erect position.
Transthoracic echocardiography demonstrated severe asymmetrical
septal hypertrophy and systolic anterior motion of the anterior
mitral valve leaflet which were diagnostic for hypertrophic
cardiomyopathy. Interestingly, color Doppler examination of
the left ventricle showed aliasing of the left anterior descending
coronary artery and intra-myocardial coronaries.
Keywords: Hypertrophic cardiomyopathy; Myocardial bridge
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Description
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A 50-year-old man presented with chest pain and recurrent episodes
of syncope. Physical examination revealed a loud systolic murmur
at the left sternal border with accentuation in erect position.
Electrocardiogram showed voltage criteria of left ventricular
hypertrophy. Transthoracic echocardiography demonstrated severe
asymmetrical septal hypertrophy (septal thickness = 50mm) (
Figure 1A)
and systolic anterior motion of the anterior mitral valve leaflet
(
Figure 1B) which were diagnostic for hypertrophic cardiomyopathy.
Interestingly, color Doppler examination of the left ventricle
showed aliasing of the left anterior descending coronary artery
(
Figure 2A) and intra-myocardial coronaries (
Figure 2B) (See
Video Clip 1 and
2). Systolic compression of the left anterior
descending coronary artery is a well-recognized angiographic
phenomenon in adult patients who have hypertrophic cardiomyopathy.
1 Myocardial bridging in adults with hypertrophic cardiomyopathy
may be associated with a higher incidence of sudden cardiac
death.
2
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Figure 1 M-mode echocardiography in para-sternal window of a patient presented with recurrent episodes of syncope. (A) Short axis view of the left ventricle at the level of papillary muscle which shows severe hypertrophy of the left ventricle more prominently in the septum. (B) M-mode echocardiography of the mitral valve in long axis view demonstrates systolic anterior motion of the mitral valve leaflets.
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Figure 2 Color Doppler echocardiography in para-sternal window of a patient presented with recurrent episodes of syncope. (A) Aliasing of left anterior descending coronary artery in short axis view of the left ventricle at the level of papillary muscle. (B) Aliasing of intramural coronary arteries in the long axis view of the left ventricle.
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Supplementary material
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Supplementary material associated with this article can be found in the online version.
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References
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- Vogt PR, Dubach P, Turina MI. Muscle bridging of the left anterior descending coronary artery. Circulation (1996) 93:614.[Free Full Text]
- Maron BJ, Epstein SE, Roberts WC. Hypertrophic cardiomyopathy and transmural myocardial infarction without significant atherosclerosis of the extramural coronary arteries. Am J Cardiol (1979) 43:1086–102.[CrossRef][Web of Science][Medline]
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