The aim of this study is to evaluate the relationship between obstruction and anomalies of the mitral and sub-valvular apparatus during primary HCM by cardiac MRI (1).

This prospective study carried out from 2011 to 2013, has included 30 patients with primary HCM confirmed on cardiac MRI or suspected on ultrasound. The MRI analysis included a descriptive morphological study of HCM (fig. 1), a study of the obstructive character, a search for abnormalities of the valvular and sub-valvular apparatus. The left ventricle has been explored by cardiac MRI with cine-acquisition. It is the multiplanar study that allows a quasi-three-dimensional study of the pillars. Obstructive character was diagnosed on turbulence in hyposignal within...

The asymmetric form was the most frequent form of MHC (70% of cases) with a predominant sigmoid form (62%). Obstruction was noted in 47% of cases. A systolic anterior movement (SAM) was objectified in 10 patients (33%). The analysis of the mitral apparatus had shown an elongation of at least one mitral valve in 37% of the cases (fig. 3). A mitral regurgitation was found in 30% of cases (fig. 4). A morphological abnormality, number or insertion abnormality of the pillars was noted in 43%...

The detection of obstruction during HCM is a major issue because it increases the risk of progression to heart failure and doubles the relative risk of cardiac death (2). SAM is often responsible for mitral insufficiency and it is one of the essential determinants of aortic obstruction in HCM (3). The obstruction may be associated or aggravated by abnormalities of the mitral and valvular apparatus, requiring precise mapping of the valve apparatus, preoperatively (3). Knowledge of the mechanism of obstruction has therapeutic implications. In fact,...

1- Gersh B, Maron BJ B, Bonow R. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2011;142:1303-38.ice Guidelines. J Thorac Cardiovasc Surg 2011;142:1303-38. 2- Maron M Set al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 2003;348:295-303. 3- Klues et al.. Diversity of structural mitral valve alterations in hypertrophic cardiomyopathy. Circulation...