Video Commentary 2
ECHOCARDIOGRAPHY FOR HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Kalpna Irpachi, K Ashok Kumar, Neha Pangasa, Poonam Malhotra Department of Cardiac Anaesthesia, CNC, AIIMS – New Delhi Introduction: Hypertrophic cardiomyopathy is a genetic syndrome frequently transmitted as an autosomal dominant trait with multiple variants that all involve an increase in LV myocardial mass. The clinical symptoms include: dyspnea, angina and dizziness. Symptomatic patients have septal wall thickness exceeding 20 mm. TEE • • • • •
Views ME 5 chamber ME- AV LAX view (video 3, 4) TG mid papillary SAX view (video 2) Deep TG LV long axis view TG LV long axis view (video 5)
(Video1)
2D- Echocardiographic TEE • Confirm the diagnosis: TG mid papillary SAX view (video 2) • TDI will identify reduced systolic (S) and diastolic (e') velocity. The reduced systolic velocity in the presence of a normal or elevated EF is suggestive of HCM. • Strain rate imaging - Differentiate the LVH of HCM from that of HTN Echocardiographic evaluation of patients with HCM • Measurements of LV dimensions and wall thickness (septal, posterior, and maximum) (Figure 1) • LVEF • RVH and assess RV dynamic obstruction • LA volume index of >34 ml/m2 shown to be predictive of LVH, severity of diastolic dysfunction, and adverse cardiovascular outcomes. • LV systolic and diastolic function, PASP • LVOT dynamic obstruction at rest and with Valsalva maneuver. • Mitral valve - Direction, mechanism, and severity of MR, SAM, evaluation of papillary muscle. In mid-systole IVS, Systolic anterior motion of MV and MR jet are examined in ME- LAX view. (Video 3) • TTE or TEE is recommended to guide for alcohol septal ablation • Screening Assessment of mitral valve • ME-LAX view or ME-5C view can be used for measurement of the leaflet length (Figure 2) • • •
AML length >33 mm are likely candidates for horizontal AML plication. The TG 2C view is ideal to determine the papillary muscle thickness and insertion. In HOCM, coaptation occurs in the body of the leaflets (Video 4)
Post cardiopulmonary bypass assessment • Confirm the adequacy of myectomy and quantitate residual gradients severity of MR (Video 5)
Full Video Commentary is available at www.annals.in, Annals of Cardiac Anaesthesia APP, www.blog.annals.in
Kalpna Irpachi, K Ashok Kumar, Nega Pangasa, Poonam Malhotra Kapoor
Access this article online Quick Response Code:
Department of Cardiac Anaesthesia, CNC, AIIMS, New Delhi, India
Website: www.annals.in
Address for correspondence: Dr. Poonam Malhotra Kapoor, Department of Cardiac Anaesthesia, CNC, AIIMS, New Delhi, India. E‑mail: [email protected]
DOI: 10.4103/0971-9784.203959 PMID: ***
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Irpachi K, Kumar KA, Pangasa N, Kapoor PM. Echocardiography for hypertrophic obstructive cardiomyopathy. Ann Card Anaesth 2017;20:279.
© 2017 Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow
279
ECHOCARDIOGRAPHY FOR HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY
Kalpna Irpachi, K Ashok Kumar, Neha Pangasa, Poonam Malhotra Department of Cardiac Anaesthesia, CNC, AIIMS – New Delhi Introduction: Hypertrophic cardiomyopathy is a genetic syndrome frequently transmitted as an autosomal dominant trait with multiple variants that all involve an increase in LV myocardial mass. The clinical symptoms include: dyspnea, angina and dizziness. Symptomatic patients have septal wall thickness exceeding 20 mm. TEE • • • • •
Views ME 5 chamber ME- AV LAX view (video 3, 4) TG mid papillary SAX view (video 2) Deep TG LV long axis view TG LV long axis view (video 5)
(Video1)
2D- Echocardiographic TEE • Confirm the diagnosis: TG mid papillary SAX view (video 2) • TDI will identify reduced systolic (S) and diastolic (e') velocity. The reduced systolic velocity in the presence of a normal or elevated EF is suggestive of HCM. • Strain rate imaging - Differentiate the LVH of HCM from that of HTN Echocardiographic evaluation of patients with HCM • Measurements of LV dimensions and wall thickness (septal, posterior, and maximum) (Figure 1) • LVEF • RVH and assess RV dynamic obstruction • LA volume index of >34 ml/m2 shown to be predictive of LVH, severity of diastolic dysfunction, and adverse cardiovascular outcomes. • LV systolic and diastolic function, PASP • LVOT dynamic obstruction at rest and with Valsalva maneuver. • Mitral valve - Direction, mechanism, and severity of MR, SAM, evaluation of papillary muscle. In mid-systole IVS, Systolic anterior motion of MV and MR jet are examined in ME- LAX view. (Video 3) • TTE or TEE is recommended to guide for alcohol septal ablation • Screening Assessment of mitral valve • ME-LAX view or ME-5C view can be used for measurement of the leaflet length (Figure 2) • • •
AML length >33 mm are likely candidates for horizontal AML plication. The TG 2C view is ideal to determine the papillary muscle thickness and insertion. In HOCM, coaptation occurs in the body of the leaflets (Video 4)
Post cardiopulmonary bypass assessment • Confirm the adequacy of myectomy and quantitate residual gradients severity of MR (Video 5)
Full Video Commentary is available at www.annals.in, Annals of Cardiac Anaesthesia APP, www.blog.annals.in
Kalpna Irpachi, K Ashok Kumar, Nega Pangasa, Poonam Malhotra Kapoor
Access this article online Quick Response Code:
Department of Cardiac Anaesthesia, CNC, AIIMS, New Delhi, India
Website: www.annals.in
Address for correspondence: Dr. Poonam Malhotra Kapoor, Department of Cardiac Anaesthesia, CNC, AIIMS, New Delhi, India. E‑mail: [email protected]
DOI: 10.4103/0971-9784.203959 PMID: ***
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Irpachi K, Kumar KA, Pangasa N, Kapoor PM. Echocardiography for hypertrophic obstructive cardiomyopathy. Ann Card Anaesth 2017;20:279.
© 2017 Annals of Cardiac Anaesthesia | Published by Wolters Kluwer - Medknow
279
