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Case Reports
. 2023 Nov 1:10:1278457.
doi: 10.3389/fcvm.2023.1278457. eCollection 2023.

Case Report: Integrated echocardiographic assessment guided Liwen procedure for treating obstructive hypertrophic cardiomyopathy with ventricular aneurysm

Rui Zhang  1 , Fan Zhao  1 , Jing Wang  1 , Yahong Qin  1 , Tingting Wang  1 , Ai-Ai Chu  1
Affiliations
Case Reports

Case Report: Integrated echocardiographic assessment guided Liwen procedure for treating obstructive hypertrophic cardiomyopathy with ventricular aneurysm

Rui Zhang et al. Front Cardiovasc Med. .

Abstract

Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease, with an estimated incidence of 0.2%-6%, and is the main cause of sudden cardiac death (SCD) in young athletes. Left ventricular apical aneurysm (LVAA) is a rare subtype of HCM, accounting for about 5% of HCM patients, and has a higher incidence of cardiovascular adverse events. In cases of hypertrophic obstructive cardiomyopathy with LVAA (HOCM-LVAA) that do not respond adequately to optimized medical therapy, the echocardiography-guided percutaneous intra-myocardial septal radiofrequency ablation (PIMSRA, Liwen procedure) emerges as a promising and effective novel therapeutic approach. In this case report, we present for the first time a comprehensive application of echocardiographic techniques, including TTE, 2-D STE, and contrast enhancement, in the diagnosis, treatment, surgical guidance, and assessment of therapeutic outcomes in a case of HOCM-LVAA.

Keywords: contrast-enhanced echocardiography; hypertrophic cardiomyopathy; hypertrophic obstructive cardiomyopathy; speckle tracking echocardiography; transthoracic echocardiography.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(Aa) Preoperative transthoracic echocardiography (TTE): left ventricular (LV) septal thickness of 20mm; (Ab) the extent of ventricular aneurysm; (Ac) left ventricular outflow tract (LVOT) obstruction at rest; (Ad) reduced strain value of local LV apex by strain echocardiography (SE). (B) LV apical entrance of the ablation needle guided by TTE. (C) Bi-plane showing ablation needle position. (Da) LV septal thickness of 12 mm after ablation; (Db) myocardial contrast-enhanced echocardiography (MCE) showing a contrast filling defect in the ablation zone; (Dc) LVOT gradient of 20 mm Hg after the ablation; (Dd) LV apical systolic synchrony detected by SE.
Figure 2
Figure 2
(A) Preoperational cardiac magnetic resonance imaging (MRI). (a) Thickened interventricular septum, (b) the extent of ventricular aneurysm, (c) myocardial interstitial fibrosis; (B) post-operational cardiac MRI. (a) Interventricular septal thickness, (b) hypoperfusion area of myocardium at the base of ventricular septum; (C) recovered strain values of local LV apex post-operation; (D) electrocardiogram post-operation; (E) sudden cardiac death score pre- and post-operation; (F) stress echocardiographic parameters of pre- and post-operation.
See this image and copyright information in PMC

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