Gibelli Giuseppe, Biasi Salvatore, Buonamici Valeria
Department of Cardiology, S Carlo Clinic, Paderno Dugnano, Milan, Italy.
J Cardiovasc Echogr. 2013 Jul-Sep;23(3):81-83. doi: 10.4103/2211-4122.123954.
A 40-year-old man was found to have hypertrophic cardiomyopathy (HCM) with severe mid ventricular obstruction. The obstruction produced two distinct left ventricular chambers with an estimated 60 mmHg continuous wave (CW) Doppler intraventricular gradient. Pulsed wave (PW) Doppler showed high velocity systodiastolic flow from apex to base and flow from base to apex confined mostly to the second half of diastole. Cardiac magnetic resonance (CMR) showed midventricular obstruction, due to septal, parietal, and to an hypertrophic, double posteromedial papillary muscle; an apical aneurysm was detected. Aneurysm is underdiagnosed by echocardiography in HCM and an accurate anatomic definition is needed if surgery is planned; thus, a CMR should always be obtained in these patients.
一名40岁男性被诊断为肥厚型心肌病（HCM）伴严重的心室中部梗阻。该梗阻导致形成两个不同的左心室腔，连续波（CW）多普勒估计心室腔内压差为60 mmHg。脉冲波（PW）多普勒显示从心尖到心底有高速收缩期和舒张期血流，而从心底到心尖的血流主要局限于舒张期后半段。心脏磁共振成像（CMR）显示心室中部梗阻，原因是室间隔、室壁以及肥厚的双后内侧乳头肌；检测到心尖部动脉瘤。在HCM中，超声心动图对动脉瘤的诊断不足，如果计划进行手术，则需要准确的解剖学定义；因此，这些患者应常规进行CMR检查。
