Mitral regurgitation in hypertrophic obstructive cardiomyopathy: relationship to obstruction and relief with myectomy
Eric H. C. Yu, MD, FACCa,
Ahmad S. Omran, MDa,
E. Douglas Wigle, MD, FACCa,
William G. Williams, MD, FACCa,
Samuel C. Siu, MD, FACCa and
Harry Rakowski, MD, FACCa
a Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
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Figure 1 Intraoperative transesophageal echocardiography images demonstrating systolic anterior motion of the anterior mitral valve leaflet (upper right panel) and an interleaflet gap (lower left panel) through which a jet of mitral regurgitation (lower right panel) is centrally directed into the left atrium. The central jet is due to the combination of LVOT obstruction and posterior mitral valve leaflet prolapse. Ao = aorta; LA = left atrium; LV = left ventricle.
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Figure 2 Transesophageal echocardiography images in three patients with hypertrophic obstructive cardiomyopathy showing: (A) Posteriorly directed mitral regurgitation jet (arrow) in a patient without independent abnormality of the mitral valve. (B) Anteriorly directed mitral regurgitation jet (arrow) in a patient with posterior mitral valve leaflet prolapse. (C) Centrally directed jet of mitral regurgitation (arrow) in a patient with mitral stenosis. Ao = aorta; LV = left ventricle; MR= mitral regurgitation.
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Figure 3 The relationship between the LVOT gradient and the mitral regurgitation jet area. LVOT = left ventricular outflow tract.
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Figure 4 The mitral regurgitation jet area pre- and postmyectomy. MR = mitral regurgitation.
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