Contrast-enhanced computed tomography with myocardial three-dimensional printing can guide treatment in symptomatic hypertrophic obstructive cardiomyopathy

Abstract

Both surgical myectomy and percutaneous transluminal septal myocardial ablation are effective treatments for drug-refractory symptomatic hypertrophic obstructive cardiomyopathy (HOCM). However, in some cases, it is not easy to elucidate the abnormal structure of left ventricular outflow obstruction to adopt these treatments. Here, we presented a young female patient with drug-refractory symptomatic HOCM. In this case, contrast-enhanced computed tomography enabled us to assess the suitability of percutaneous transluminal septal myocardial ablation. By creating three-dimensional printed models using computed tomography data, we could also visualize intracardiac structure and simulate the surgical procedure. A multimodality assessment strategy is useful for evaluating patients complicated with drug-refractory symptomatic HOCM.

Keywords: 3D printing; Hypertrophic obstructive cardiomyopathy; Surgical myectomy.

Figure 1

Coronary angiography and computed tomographic short axis view. (A) Right anterior oblique cranial view. (B) Right anterior oblique caudal view. White arrow indicates the first septal branch, and black arrow indicates the second septal branch. (C) The first septal branch (white arrow) supplies the myocardium related to the left ventricular outflow tract obstruction. (D) The second septal branch (black arrow) supplies the myocardium at the inferior‐posterior mid portion.

Figure 2

Transesophageal echocardiography before surgery. (A) Systolic anterior motion of the mitral valve, and mitral valve leaflet‐septal contact were observed (white arrow). (B) Relatively thin septal wall (maximum wall thickness 17 mm) was observed (black arrow). (C) Severe mitral regurgitation and acceleration flow at the left ventricular outflow tract were observed. (D) Abnormal chordae were observed (yellow arrow). Ao, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Figure 3

Three‐dimensional (3D) printed model of hypertrophic obstructive cardiomyopathy. (A) through (B) 3D printing showed left ventricle geometry. (C) Intracardiac geometry. Black arrow shows abnormally thickened chordae. (D) Simulation of myectomy using 3D printed model.

Figure 4

Intraoperative photography. (A) The view is from the aortic side looking into the left ventricle. The surgeon is cutting the septal myocardium using a surgical scalpel. Hypertrophied septal wall was resected. (B) Abnormal chordae were also resected (black arrow). (C) Plication of posterior mitral valve was performed (white arrow).