Kawagoe Katsuya, Furukawa Koji, Ishi Hirohito, Sakaguchi Shuhei, Taniguchi Tomoaki, Meiri Risa, Yamamura Yoshimasa
Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
J Cardiol Cases. 2025 Jan 14;31(4):101-104. doi: 10.1016/j.jccase.2024.12.006. eCollection 2025 Apr.
Anomalous papillary muscles (PMs), in which the PMs are directly attached to the anterior mitral valve (MV) leaflet, can cause obstruction of the left ventricular outflow tract (LVOT). Accurately diagnosing of anomalous PMs, understanding their pathology, and performing appropriate surgery are essential for relieving LVOT obstruction effectively.A 71-year-old man with hypertrophic obstructive cardiomyopathy was referred to our hospital. Transthoracic echocardiography revealed LVOT obstruction with a peak outflow pressure gradient of 63 mm Hg at rest and 96 mm Hg during the Valsalva maneuver. Furthermore, an anomalous PM was suspected to be the cause of LVOT obstruction. Three- and four-dimensional cardiac computed tomography (CT) images clearly demonstrated that an anomalous PM from the anterior PMs was directly attached to the body of the anterior MV leaflet and that the anomalous PM, together with the thickened ventricular septum, caused a dynamic obstruction of the LVOT. We resected the anomalous PM from the anterior PMs and the subaortic ventricular septum using a transaortic approach.In this case, preoperative three-dimensional and four-dimensional cardiac CT images were effective at revealing the presence of an anomalous PM and its pathology in patient with LVOT obstruction, leading to accurate and smooth surgical procedures and improved patient outcomes.
•Anomalous PMs are classified by their attachment patterns and appropriate surgical methods are recommended for each type, providing valuable insights for clinical decision-making.•This report emphasizes the significance of 3D and 4D cardiac CT in identifying the causes of LVOTO. This imaging technique provides important information regarding the location of the anomalous PM and dynamic impact, leading to a successful surgical outcome.
异常乳头肌（PMs），即乳头肌直接附着于二尖瓣（MV）前叶，可导致左心室流出道（LVOT）梗阻。准确诊断异常乳头肌，了解其病理情况，并进行适当的手术，对于有效缓解LVOT梗阻至关重要。一名71岁的肥厚型梗阻性心肌病男性患者被转诊至我院。经胸超声心动图显示LVOT梗阻，静息时峰值流出道压力梯度为63 mmHg，瓦尔萨尔瓦动作时为96 mmHg。此外，怀疑异常乳头肌是LVOT梗阻的原因。三维和四维心脏计算机断层扫描（CT）图像清楚地显示，一根来自前乳头肌的异常乳头肌直接附着于前MV叶体部，且该异常乳头肌与增厚的室间隔一起导致了LVOT的动态梗阻。我们采用经主动脉途径从前乳头肌和主动脉下室间隔切除了异常乳头肌。在该病例中，术前三维和四维心脏CT图像有效地揭示了LVOT梗阻患者异常乳头肌的存在及其病理情况，使得手术过程准确且顺利，并改善了患者的预后。
•异常乳头肌根据其附着模式进行分类，并针对每种类型推荐了合适的手术方法，为临床决策提供了有价值的见解。•本报告强调了三维和四维心脏CT在识别LVOTO病因方面的重要性。这种成像技术提供了有关异常乳头肌位置和动态影响的重要信息，从而带来成功的手术结果。
