(Circulation. 1998;97:2372-2374.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Coronary Artery Ectasia and Systolic Flow Cessation in Hypertrophic Cardiomyopathy
Stephan Gielen, MD;
Ruth H. Strasser, MD;
Wolfgang Kübler, MD;
; Christlieb Haller, MD
From the Department of Internal Medicine III, University of Heidelberg,
Germany.
Correspondence to C. Haller, MD, Medizinische Klinik III, Universität Heidelberg, Bergheimer Str 58, 69115 Heidelberg, Germany. E-mail challer@krzmail.krz.uni-heidelberg.de
Case Report
A 24-year-old woman was evaluated for exertional dyspnea and chest
pain. Echocardiography showed marked apical, septal
(14 mm), and anterolateral (21 mm) hypertrophy
with normal inferior and posterior wall thickness (Figure 1
). The patient underwent right and left
heart catheterization, with coronary and
biventricular angiography. The cardiac index was 2.2 L
· min-1 · m-2.
The left ventricular pressure was 100/0 to 10 mm Hg,
without evidence of an intracavitary gradient. Right anterior oblique
ventriculography demonstrated a subtotal obliteration of the left
ventricular cavity during systole (Figure 2). Simultaneous right and
left ventricular angiography revealed a massively thickened
interventricular septum (Figure 3). Coronary angiography showed
no hemodynamically relevant fixed stenosis. The
striking finding was the dilation and pronounced tortuosity of the
coronary arteries, particularly the left anterior descending
arterial (LAD) system (Figure 4, bottom), without signs of a coronary
artery-to-left ventricular fistula. The coronary perfusion
pattern of the LAD showed marked dynamic changes: the dye propagation
occurred only during ventricular diastole;
during systole, radiocontrast flow practically ceased, with apparent
obliteration of the vascular lumen. Figure 4 shows the left
coronary arterial system during the same cardiac
cycle: during systole, the LAD system is "squeezed empty" (Figure 4, top), while the same vessels are rapidly filled during the
subsequent diastole (Figure 4, bottom). The dynamic changes
of luminal diameter are illustrated quantitatively in Figure 5. The caliber of a compressed and
noncompressed branch of the LAD (Figure 4, top and bottom, arrows) . . . [Full Text of this Article]
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