1 From the Cardiology Unit, Department of Medicine and the Department of Radiology, University of Rochester School of Medicine, and the Medical Clinic of Strong Memorial Hospital, Rochester, New York.
Simultaneous recordings of reflected ultrasound from the anterior mitral leaflet and left ventricular outflow, the ECG, the phonocardiogram, and a recording of the carotid artery pulse were obtained in six patients with hypertrophic obstructive cardiomyopathy. Abnormal sharp systolic anterior movement (SAM) of the mitral leaflet was observed. This movement began with the onset of ventricular ejection and reached a peak with the initial peak in the arterial pulse. The leaflet was apposed to the interventricular septum up to 60% of the ejection period. In the latter part of systole as the mitral leaflet moved away from the interventricular septum, the arterial pulse showed a second systolic wave. Onset of SAM coincided with onset of the systolic murmur. Spontaneous variations in amplitude of SAM coincided with alterations in contour of the arterial pulse and in the intensity of the murmur. Administration of methoxamine to four patients resulted in disappearance of SAM. In one patient following surgery, the SAM of the mitral leaflet was noted only in the post-ectopic beats. This specific abnormality of mitral leaflet movement represents the localization of dynamic outflow obstruction in hypertrophic obstructive cardiomyopathy.
© 1969 American Heart Association, Inc.
Ultrasound Localization of Left Ventricular Outflow Obstruction in Hypertrophic Obstructive Cardiomyopathy
Key Words: Idiopathic hypertensive subaortic stenosis (IHSS) • Systolic anterior movement • Anterior mitral leaflet
This article has been cited by other articles:
 |
|
 |
|
  J. Ross Jr Transseptal left heart catheterization a 50-year odyssey. J. Am. Coll. Cardiol., June 3, 2008; 51(22): 2107 - 2115. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Zywica, R. Jenni, P.A. Pellikka, A. Faeh-Gunz, B. Seifert, and C.H. Attenhofer Jost Dynamic left ventricular outflow tract obstruction evoked by exercise echocardiography: prevalence and predictive factors in a prospective study Eur J Echocardiogr, April 23, 2008; (2008) jen070v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-i. Morimoto, A. Sugiura, M. Iwase, N. Kubo, S. Hiramitsu, A. Uemura, M. Ohtsuki, S. Kato, Y. Kato, and H. Hishida Relief of Left Ventricular Outflow Obstruction by Cibenzoline in a Patient With Fabry's Disease: A Case Report Angiology, March 1, 2006; 57(2): 241 - 245. [Abstract] [PDF]
|
|
|
|
|
|
C. Autore, P. Bernabo, C. S. Barilla, P. Bruzzi, and P. Spirito The prognostic importance of left ventricular outflow obstruction in hypertrophic cardiomyopathy varies in relation to the severity of symptoms J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1076 - 1080. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Maron, J. A. Dearani, S. R. Ommen, M. S. Maron, H. V. Schaff, B. J. Gersh, and R. A. Nishimura The case for surgery in obstructive hypertrophic cardiomyopathy J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2044 - 2053. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hamada, Y. Shigematsu, K. Ohshima, J. Suzuki, A. Ogimoto, T. Ohtsuka, and Y. Hara Diagnostic Usefulness of Carotid Pulse Tracing in Patients With Hypertrophic Obstructive Cardiomyopathy Due to Midventricular Obstruction: A Comparison With Idiopathic Hypertrophic Subaortic Stenosis Chest, October 1, 2003; 124(4): 1275 - 1283. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. D. McPherson and C. K. Holland Seizing the science of ultrasound: Beyond imaging and into physiology and therapeutics J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1628 - 1630. [Full Text] [PDF]
|
|
|
|
 |
|
 M. V. Sherrid, F. A. Chaudhry, and D. G. Swistel Obstructive hypertrophic cardiomyopathy: echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction Ann. Thorac. Surg., February 1, 2003; 75(2): 620 - 632. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Schwammenthal, S. Nakatani, S. He, J. Hopmeyer, A. Sagie, A. E. Weyman, H. M. Lever, A. P. Yoganathan, J. D. Thomas, and R. A. Levine Mechanism of Mitral Regurgitation in Hypertrophic Cardiomyopathy : Mismatch of Posterior to Anterior Leaflet Length and Mobility Circulation, September 1, 1998; 98(9): 856 - 865. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. D. Wigle, H. Rakowski, B. P. Kimball, and W. G. Williams Hypertrophic Cardiomyopathy : Clinical Spectrum and Treatment Circulation, October 1, 1995; 92(7): 1680 - 1692. [Full Text]
|
|
|
|
|
|
B. J. Maron, J. M. Gardin, J. M. Flack, S. S. Gidding, T. T. Kurosaki, and D. E. Bild Prevalence of Hypertrophic Cardiomyopathy in a General Population of Young Adults : Echocardiographic Analysis of 4111 Subjects in the CARDIA Study Circulation, August 15, 1995; 92(4): 785 - 789. [Abstract] [Full Text]
|
|
|
|
 |
|
 H. Rowell, H. Racker, and R. C. Bansal Spectrum of Hyperirophic Cardiomyopathy Viewed by M-Mode, 2D, and Doppler Echocardiography: A Review Journal of Diagnostic Medical Sonography, January 1, 1986; 2(1): 24 - 30. [Abstract] [PDF]
|
|
|
|
|
|
J. A. Ambrose and H. S. Friedman Changing Diastolic Closure Rates (E to F Slopes) in a Patient With Mitral Stenosis: A Case Report Angiology, January 1, 1979; 30(1): 62 - 66. [Abstract] [PDF]
|
|
|
|
|
|
M. G. Pandian, J. G. Greenwald, A. Lichtman, and H. Truax Pulmonary Hypertension Associated With Echocardiographic Pseudoid-Iopathic Hypertrophic Subaortic Stenosis Angiology, January 1, 1977; 28(1): 36 - 39. [Abstract] [PDF]
|
|
|
|
|
|
A.S. Abbasi Current Application of Echocardiography Angiology, April 1, 1975; 26(4): 303 - 316. [PDF]
|
|