ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Apical biventricular hypertrophic cardiomyopathy arising from the right ventricle and spontaneous apical left ventricle perforation
Osman Tiryakioğlu1, Hakan Vural 1, Selma Kenar Tiryakioğlu 2, Hakan Özkan 2, Vedat Koca2
1Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Bursa
2Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Bursa
Hypertrophic cardiomyopathy is often associated with a left ventricular disease; right ventricular dysfunction and biventricular involvement are rare entities. A 49-year-old woman presented with complaints of fatigue, palpitation, and exertional dyspnea. Echocardiographic findings were consistent with hypertrophic cardiomyopathy involving both ventricles. Cardiac magnetic resonance imaging showed apical biventricular hypertrophy and a mass lesion at the apex. A fine needle biopsy from the mass under spiral computed tomography guidance revealed an organized thrombus. Right heart catheterization showed severe tricuspid regurgitation and a filling defect at the right ventricular apex. Left ventriculography revealed a spade-like appearance and contrast filling from the left ventricular apex into the mass. Upon worsening of her clinical condition, a decision for surgery was made. At surgery, an apical mass, 3x3 cm in size, was noted close to the right ventricle. Excision of the mass disclosed a passage to the left ventricle. The defect was closed with a Teflon patch and tricuspid annuloplasty was performed. During the postoperative period, signs of insufficiency showed a marked regression. Pathological sections from the myocardial biopsies were consistent with hypertrophic cardiomyopathy.
Keywords : Cardiomyopathy, hypertrophic/diagnosis; heart ventricles; hypertrophy, right ventricular; rupture, spontaneous
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