"Sawfish" systolic narrowing of the left anterior descending coronary artery: an angiographic sign of hypertrophic cardiomyopathy.

Abstract

SUMMARY The morphologic characteristics at coronary arteriography of systolic narrowing of the left anterior descending coronary artery (LAD) were evaluated in 14 patients. Six patients had systolic narrowing of the LAD not associated with other cardiac abnormalities (group A) and eight patients had systolic narrowing of the LAD associated with hypertrophic cardiomyopathy (group B). Patients in group A showed a smooth and progressive constriction of the vessel up to the point of maximal stenosis, giving it a "rat-tail" appearance. There was no systolic narrowing of septal branches or of other epicardial vessels in this group. In patients of group B, systolic narrowing of the LAD had a "saw-fish" appearance. Seven patients had systolic narrowing of the septal branches, and five had systolic narrowing of other epicardial vessels. These data indicate that systolic narrowing of the LAD in patients with hypertrophic cardiomyopathy differs angiographically from systolic narrowing due to an intramural course of a part of the vessel (as in group A patients). We postulate that in patients with hypertropic cardiomyopathy, fiber hypertrophy and disarray in the vicinity of the coronary vessels is responsible for the morphology and the widespread distribution of systolic narrowing. SYSTOLIC NARROWING ("milking" or "bridging") of the left anterior descending coronary artery (LAD) at angiography is a well-known phenomenon.'-5 It occurs both as an isolated finding at cardiac catheterization and in patients with arteriosclerotic coronary artery disease, left ventricular hypertrophy and hypertrophic cardiomyopathy. The angiographic morphology of systolic narrowing of the LAD has not been analyzed in relation to the underlying heart disease, and it is not known whether the same pathologic basis accounts for systolic narrowing of the LAD in patients with or without heart disease. We studied the morphologic aspect at angiography of systolic narrowing of the LAD in six patients without hypertrophic cardiomyopathy, left ventricular hypertrophy or any other form of heart disease and in eight patients with hypertrophic cardiomyopathy. Methods PatientsWe reviewed the records of 520 patients who underwent cardiac catheterization and coronary angiography. In six patients with otherwise normal coronary arteries and no associated cardiovascular abnormalities part of the LAD had an intramural course that produced systolic narrowing (group A. patients 1-6). In eight of 15 patients with hypertrophic cardiomyopathy and otherwise normal coronary arteries, systolic narrowing of the LAD was demonstrated by selective coronary arteriograms (group B, patients 7-14). Hypertrophic cardiomyopathy was diagnosed from the characteristic echocardiogram, left ventriculogram and an intraventricular pressure gradient at rest or after provocation by induced extrasystoles. In one patient with characteristic electrocardiographic and angiographic findings of hypertrophic cardiomyopathy and no gradient at rest, provocation was not attempted. In one patient, an intra...

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“…A "sawfish" pattern of narrowing of the vessel during systole may be unique to hypertrophic cardiomyopathy. 42 Miscellaneous Laboratory Tests. Programmed electrical stimulation of the heart in patients with severe obstruction may identify those who are unusually vulnerable to lifethreatening ventricular tachycardia or ventricular fibrillation.…”

Systolic narrowing of the left anterior descending coronary artery in hypertrophic cardiomyopathy

“…Systolic narrowing of the left anterior descending coronary artery and/or its first septal perforator without myocardial bridging has been described in hypertrophic cardiomyopathy for the past 30 years [2][3][4][5][6][7]. It, however, differs from systolic compression due to myocardial bridging in 2 important respects:…”

“…(1) Systolic narrowing of the left anterior descending coronary artery in hypertrophic cardiomyopathy has a "sawfish" appearance on angiogram, whereas that due to myocardial bridging has a "rat-tail" appearance [3]. (2) Systolic narrowing of the first septal perforator is absent in myocardial bridging, but present frequently in hypertrophic cardiomyopathy [2].…”