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