Role of cardiac magnetic resonance (CMR) in planning ventricular septal myomectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM)

Abstract

Septal myectomy is currently the gold standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure needs to be tailored and performed in a personalized fashion, taking into consideration the anatomic and physiologic heterogeneity of this disease. The extent and location of surgical myectomy will depend on the location of the hypertrophy, with the goal of widening the outflow tract and improve the function of the mitral valve. CMR helps to identify hypertrophy not well visualized by TTE, providing more accurate wall thickness measurements and differentiating HOCM from other causes of LV hypertrophy. CMR also helps identify an abnormal attachment of papillary muscle to the MV or to the septal myocardium and mitral valve pathology. A collaborative approach with cardiac surgeons, radiologists and cardiologists will optimize preoperative planning to improve the success for surgical myectomy.

The mitral valve in hypertrophic cardiomyopathy

“…and myocardial perfusion imaging. CMR may also provide better assessment of LV apical morphology and function than TTE; for example, the detection of LVMCO and LV apical aneurysms [34].…”

“…The decision to proceed with adjuvant mitral valve modification during surgery is guided by the adequate identification of abnormal submitral apparatus, identified by multimodality imaging and confirmed by direct visualization during the procedure [19,34,43]. The presence of a posterior mitral regurgitation jet, in the absence of obvious other mitral valve disease, is deemed typical of SAM-mediated mitral regurgitation.…”