Left ventricle accessory antero-septal papillary muscle: an echocardiography and cardiac MRI case-series in controls and hypertrophic obstructive cardiomyopathy patients

Abstract 16994: Left Ventricle Accessory Antero-Septal Papillary Muscle Detected in the LVOT Vicinity by Means of Cardiac MRI and Echocardiography in HOCM and Control Patients

Circulation ◽

10.1161/circ.142.suppl_3.16994 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

George O Angheloiu ◽

Robert W Biederman

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Papillary Muscle ◽

Cardiac Mri ◽

Physiological Significance ◽

Accessory Muscle ◽

Early Systole ◽

And Control

Background: We studied by means of echocardiography (echo) and cardiac MRI the occurrence of an accessory papillary muscle that unites mostly the left ventricle (LV) apex with the basal or mid antero-septum. Methods: We included all good quality studies as reviewed by two cardiologists and assessed the occurrence of a contractile papillary muscle situated between the LV apex and antero-septum. Results: A contractile accessory papillary muscle situated between the LV apex and the antero-septum was seen in 100% of HOCM patients and 62% of control patients (p=0.05, panels 1-6 HOCM patients and 7-9 controls; panels 1, 4 and 7 - diastole; 2,5 and 8 - early-systole; 3, 6 and 9 - end-systole) in the cardiac MRI images acquired from a total of 22 HOCM (9) and control (13) patients. The same structure was observed in 241 patients representing 69.5% of all-comers echo studies. The age was 69 ± 17 years on average in the echo arm, patients harboring the antero-septal accessory muscle being older (71.6 + 15.7 years old vs 63.5 ± 18.1 for those without, p=0.0005). We exemplify this structure by parasternal long axis still echo images from 24 patients (panel 14) as well as more detailed images from 4 patients in the same group (panels 10-13). Red arrows point out the accessory antero-septal papillary muscle and white arrows the antero-septum. Pink and yellow dots neighbor the regular antero-lateral and postero-medial pap muscles and the white dots the mitral valve. Conclusion: A contractile accessory papillary muscle was observed in slightly more than half of the all-comer echo studies, and in all HOCM patients in the cardiac MRI arm. Further research is needed to fully characterize the anatomical and physiological significance of this structure attaching in the immediate vicinity of the LVOT in HOCM and control patients.

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Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

The Heart Surgery Forum ◽

10.1532/hsf98.20111185 ◽

2012 ◽

Vol 15 (5) ◽

pp. 251

Author(s):

Changqing Gao ◽

Chonglei Ren ◽

Cangsong Xiao ◽

Yang Wu ◽

Gang Wang ◽

...

Keyword(s):

Mitral Valve ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Surgical Procedures ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Systolic Anterior Motion ◽

Anterior Leaflet ◽

Septal Myectomy ◽

The Mean

Background: The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).Methods: Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.Results: All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (P = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (P = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.Conclusions: Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.

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Brugada syndrome unmasked by left ventricle posteromedial papillary muscle ventricular tachycardia: Coincidence or consequence

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2021.08.021 ◽

2021 ◽

Author(s):

Javier Pinos ◽

Tiago Luiz Luz Leiria ◽

Bernardo Boccalon ◽

Marcelo Lapa Kruse ◽

Gustavo Glotz De Lima

Keyword(s):

Ventricular Tachycardia ◽

Left Ventricle ◽

Papillary Muscle ◽

Brugada Syndrome

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Inter-Basal and Septal Connections of Papillary Muscles - An Anatomical Rationale for Rhythmic Opening of AV Valves - A Multicentric Medical College Based Cross Sectional Study

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/523 ◽

2021 ◽

Vol 8 (31) ◽

pp. 2865-2869

Author(s):

Praveen Mulki Shenoy ◽

Amith Ramos ◽

Narasimha Pai ◽

Bharath Shetty ◽

Aravind Pallipady Rao

Keyword(s):

Left Ventricle ◽

Papillary Muscle ◽

Interventricular Septum ◽

Cross Sectional Study ◽

Papillary Muscles ◽

Cross Sectional ◽

Medical College ◽

Moderator Band ◽

Almost All ◽

And Function

BACKGROUND The papillary muscle basal connections have significant clinical implications. Variety of studies done on its morphology and function by various specialists in different departments. A close look on these revealed the interconnections of papillary muscles to one another and to the interventricular septum of both ventricles is related to uncoordinated contractions of papillary muscles, leading to hyper or hypokinesia or prolapse or even its rupture. METHODS Our study done in 25 formalin soaked hearts revealed after the deep and meticulous dissection, reflecting the walls of ventricles laterally the numerous interconnections of papillary muscles at its bases and IVS. Ventricles are opened by inverted ‘L’ shaped incision and its reflected more laterally till all the papillary muscles is visible in one frame after incising the moderator band. The connections were noted, measured, photographed, tabulated, compared with similar studies and analysed with experts with respective fields. RESULTS Almost all the specimens did have the interconnections. Further the post mortem findings of the cardiac related deaths with involvement of papillary muscles suggest damage to such ‘bridges’. The moderator band extensions to the base of right APM, and its extension to the posterior groups is noted in all the specimens. The bridge from the IVS to bases of both the groups of papillary muscles is noted in left ventricle. In90% of specimens the one PPM is found to be loosely connected, more so in left ventricle. CONCLUSIONS We are of a conclusion that such basal interconnections and to the interventricular septum are responsible for rhythmic contractions of papillary muscles of both ventricles. Since the AV valves have to open simultaneously, interconnections becomes mandatory as the impulse has to reach it before it reaches the trabeculae carniae. One of the Posterior papillary muscles is loosely connected to other papillary muscles, may be the reason for its rupture, more so in left ventricle. KEYWORDS Papillary Muscle, Interbasal Connection, Moderator Band, Valvular Prolapse, AV Valves

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Fast fully automatic multiframe segmentation of left ventricle in cardiac MRI images using local adaptive k-means clustering and connected component labeling

2015 2nd International Conference on Signal Processing and Integrated Networks (SPIN) ◽

10.1109/spin.2015.7095354 ◽

2015 ◽

Cited By ~ 3

Author(s):

Anupama Bhan ◽

Ayush Goyal ◽

Vinayak Ray

Keyword(s):

Left Ventricle ◽

Cardiac Mri ◽

Connected Component ◽

Connected Component Labeling ◽

Fully Automatic

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Clinically Suspected Myocarditis in COVID-19 Patients: Case Series and Review of Literature

10.22541/au.162757208.89784925/v1 ◽

2021 ◽

Author(s):

Ahmad Amin ◽

Seyed Parsa Eftekhar ◽

Naghmeh Ziaei ◽

Soudeh Roudbari ◽

Pegah Salehi ◽

...

Keyword(s):

Severe Acute Respiratory Syndrome ◽

Left Ventricle ◽

Ejection Fraction ◽

Case Series ◽

Female Gender ◽

Good Prognosis ◽

Left Ventricle Ejection Fraction ◽

Review Of Literature ◽

Younger Age ◽

Poor Outcomes

We described eleven patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The younger age and female gender seem to contribute to poor outcomes possibly. Furthermore, the left ventricle ejection fraction and pro-BNP improvement within the first week of treatment might indicate a good prognosis.

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