Leon H. Charney Division of Cardiology, Echocardiography Laboratory, Hypertrophic Cardiomyopathy Program, New York, New York.
Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York.
J Am Soc Echocardiogr. 2021 Jan;34(1):89-96. doi: 10.1016/j.echo.2020.08.019. Epub 2020 Oct 12.
Left ventricular outflow tract (LVOT) obstruction in hypertrophic cardiomyopathy (HCM) is often caused by systolic anterior motion (SAM) of the mitral valve caused by the interplay between increased left ventricular (LV) wall thickness and an abnormal mitral valve anatomy and geometry. Three-dimensional (3D) echocardiographic imaging of the mitral valve has revolutionized the practice of cardiology, paving the way for new methods to see and treat valvular heart disease. Here we present the novel and incremental value of 3D transesophageal echocardiography (TEE) of SAM visualization. This review first provides step-by-step instructions on acquiring and optimizing 3D TEE imaging of SAM. It then describes the unique and novel findings using standard 3D TEE rendering as well as dynamic mitral valve modeling of SAM from 3D data sets, which can provide a more detailed visualization of SAM features. The findings include double-orifice LVOT caused by the residual leaflet, the dolphin smile phenomenon, and delineation of SAM width. Finally, the review discusses the essential role of 3D TEE imaging for preprocedural assessment and intraprocedural guidance of surgical and novel percutaneous treatments of SAM.
左心室流出道（LVOT）梗阻在肥厚型心肌病（HCM）中通常是由二尖瓣收缩期前向运动（SAM）引起的，这是由左心室（LV）壁厚度增加和二尖瓣解剖和几何结构异常之间的相互作用引起的。二尖瓣的三维（3D）超声心动图成像彻底改变了心脏病学的实践，为治疗瓣膜性心脏病开辟了新的方法。在这里，我们介绍了 SAM 可视化的 3D 经食管超声心动图（TEE）的新颖和增量价值。本综述首先提供了获取和优化 SAM 的 3D TEE 成像的分步说明。然后描述了使用标准 3D TEE 渲染以及从 3D 数据集动态二尖瓣建模获得的独特和新颖的发现，这可以更详细地显示 SAM 的特征。这些发现包括由残留瓣叶引起的双孔 LVOT、海豚微笑现象以及 SAM 宽度的描绘。最后，该综述讨论了 3D TEE 成像在 SAM 的术前评估和手术及新型经皮治疗的术中指导中的重要作用。
