Myocardial crypts, recesses, and outpouchings: it is time to clarify

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiovascular disease with prevalence of 0.2% in the population. More than 1000 mutations in more than 10 genes encoding for proteins of the cardiac sarcomere have been identified. Cardiac magnetic resonance imaging (CMR) is used to characterize left ventricular morphology with great precision in patients with HCM and it identifies unique structural abnormalities in patients with HCM. We present a case of a 56-year-old man who had positive family history of HCM who was a carrier of the genetic MYH-7 2770 G > C, exon 23 mutation. Transthoracic echocardiography showed thickening of the interventricular septum (16 mm) and in particular the basal septum. CMR confirmed the diagnosis of HCM in the anteroseptal myocardium with a thickness of 23 mm and also revealed large and deep myocardial crypts in the anterior wall. These myocardial crypts are rarely found in the so-called genotype positive and phenotype positive patients, as in our case. Also the crypts in this case are deeper and wider than those reported in other cases. So in conclusion, this case reveals an uncommon finding of a myocardial crypt at an unusual myocardial site with the unusual morphology in a patient with genotypic and phenotypic expression of hypertrophic cardiomyopathy.

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Letter by Puntmann et al Regarding Article, “Prevalence and Clinical Profile of Myocardial Crypts in Hypertrophic Cardiomyopathy”

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.112.977074 ◽

2012 ◽

Vol 5 (5) ◽

Cited By ~ 2

Author(s):

Valentina O. Puntmann ◽

Christian Jansen ◽

Eike Nagel

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Clinical Profile ◽

Myocardial Crypts

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Congenital diverticulum of the left ventricle – diagnosis with echocardiography, ventriculography and magnetic resonance imaging: clinical case

Bulgarian Cardiology ◽

10.3897/bgcardio.26.e54638 ◽

2020 ◽

Vol 26 (3) ◽

pp. 74-82

Author(s):

Gloria Adam ◽

Ina Tsareva ◽

Galina Kirova ◽

Ivo Petrov

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Left Ventricle ◽

Clinical Symptoms ◽

Resonance Imaging ◽

Cardiac Wall ◽

Invasive Method ◽

Electrocardiographic Changes ◽

Magnetic Resonance Imaging Mri ◽

Myocardial Crypts

Myocardial diverticula are rare and incidental ﬁ ndings. They are most probably congenital anomalies of the cardiac wall, mainly of the left ventricle (LV), which in the majority of the cases are associated with other anomalies – cardiac, vascular or thoraco-abdominal. The lack of speciﬁ c clinical symptoms and electrocardiographic changes in the presence of cardiac diverticulum, make them most commonly an incidental ﬁ nding during a diagnostic imaging examination. The diagnosis of LV diverticulum can be made with echocardiography, left ventriculography, computed tomography or magnetic-resonance imaging (MRI). Among all, MRI gives the best morphologic assessment of the ventricular wall, the location and the relation of the diverticulum to surrounding structures and its dynamic behaviour during systole and diastole. MRI can rule out inﬂ ammatory, traumatic and ischemic cardiac pathology, and cardiomyopathy, and thus differentiate the diverticulum from another entity – myocardial crypts, pathologically formed focal aneurysm or pseudoaneurysm of the LV. Therefore, MRI is the preferred non-invasive method for evaluating the cardiac wall in detail and helps to differentiate and deﬁ nitively diagnose congenital cardiac diverticulum, which in most cases does not require therapeutic intervention.

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Diagnostic opportunities of magnetic resonant imagingmri of heart in differential diagnosis of phenotypical forms of hypertrophic cardiomyopathy

Diagnostic radiology and radiotherapy ◽

10.22328/2079-5343-2020-11-4-44-51 ◽

2021 ◽

Vol 11 (4) ◽

pp. 44-51

Author(s):

A. A. Malov ◽

R. K. Dzhordzhikiya ◽

A. I. Abushayev

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Mitral Valve ◽

Short Pulse ◽

Interventricular Septum ◽

Left Ventricular ◽

Papillary Muscles ◽

Post Contrast ◽

Lv Remodeling ◽

Myocardial Crypts ◽

Tissue Characteristics

Introduction. Phenotype variants of left ventricular (LV) remodeling in patients with hypertrophic cardiomyopathy (HCM) are often associated with abnormalities of the mitral valve (MV), myocardiumstructure, contributing to the development of medium and/or subaortic obstruction. Itcauses the detail visualization of morphological obstruction substrates, tissue characteristics.Aim. To evaluate the possibilities of magnetic resonance imaging (MRI) in the diagnosis of various forms of HCM and combined abnormalities.Materials and methods. 75 patients with suspected HCM were examined. For verification, all patients underwentMRI using protocol: short-pulse T1w-TSE/ T2w-TSE (STIR), gradient echo in cine (CINE), T1-weighted post-contrast images (Inversion Recovery IR-MDE). Results. Patients classified into 4 types according to the anatomical principle (Wiggle E.D. et al., 1985). In addition to the most frequent forms affecting the interventricular septum (IVS) — 64 patients, unusual forms covering the apical zones and papillary muscles — 11 patients. The majority of patients were diagnosed with abnormalities of MV, divided into abnormalities of the number and position of papillary muscles, as well as the ratio of chords and muscles. Myocardial crypts were diagnosed in 12 patients, some combined with areas of non-compact myocardium. Post-contrast visualization using the delayed contrast technique allowed differentiating HCM with accumulation diseases, excluding cavity thrombosis, and evaluating the severity of myocardial fibrosis.Conclusions. MRI allows to estimate in details anatomic picture of LV remodeling, to diagnose features of the mitral valve, tissue characteristics that allows to stratify risk of sudden death, classify the HCM phenotype form and to determine the volume of surgical intervention.

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Left ventricular myocardial crypts: morphological patterns and prognostic implications

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa020 ◽

2020 ◽

Vol 22 (1) ◽

pp. 75-81 ◽

Cited By ~ 2

Author(s):

Per E Sigvardsen ◽

Michael H C Pham ◽

Jørgen T Kühl ◽

Andreas Fuchs ◽

Shoaib Afzal ◽

...

Keyword(s):

General Population ◽

Cardiovascular Events ◽

Cox Regression ◽

Cardiac Computed Tomography ◽

Left Ventricular ◽

Specific Pattern ◽

Hazard Ratio ◽

Major Adverse Cardiovascular Events ◽

General Population Study ◽

Myocardial Crypts

Abstract Aims Left ventricular (LV) myocardial crypts are considered a subtle marker of hypertrophic cardiomyopathy. However, crypts have also been observed in seemingly healthy individuals and it is unknown whether myocardial crypts are associated with adverse outcome. Methods and results Myocardial crypts were defined as invaginations traversing >50% of the myocardial wall and assessed using contrast-enhanced cardiac computed tomography in 10 097 individuals from the Copenhagen General Population Study. Number of crypts, location, shape, penetrance, and volume were assessed. The endpoint was a composite of major adverse cardiovascular events and defined as death, myocardial infarction, heart failure, or stroke. Cox regression models were adjusted for clinical variables, medical history, electrocardiographic parameters, and cardiac chamber sizes. A total of 1199 LV myocardial crypts were identified in 915 (9.1%) individuals. Seven hundred (6.9%) had one crypt and 215 (2.1%) had multiple crypts. During a median follow-up of 4.0 years (interquartile range 1.5–6.7), major adverse cardiovascular events occurred in 619 individuals. Individuals with one or multiple crypts had a hazard ratio for major adverse cardiovascular events of 1.00 [95% confidence interval (CI): 0.72–1.40; P = 0.98] and 0.90 (95% CI: 0.47–1.75; P = 0.76), respectively, compared with those with no crypts. No specific pattern of crypt location, shape, penetrance, or volume was associated to an increased hazard ratio for major adverse cardiovascular events. Conclusion LV myocardial crypts are frequent in the general population and are not associated with intermediate-term major adverse cardiovascular events.

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