Muscular Mitral Chord Contribution to Left Ventricular Outflow Tract Obstruction in HOCM

Abstract

Papillary muscle anomaly with a muscular chord directly attached to the anterior mitral leaflet is a rare mitral valve disease. A 62-year-old man with systolic anterior motion of the anterior mitral leaflet and hypertrophic obstructive cardiomyopathy presented to surgical intervention after unsuccessful transcoronary ablation of septal hypertrophy with alcohol. Intraoperative findings revealed a primarily not detected anomalous muscular mitral chord (0.8 × 2.2 cm) connecting the base of the A1 segment to the anterolateral papillary muscle. Resection of this chord and additional septal myectomy treated systolic anterior motion and obstruction of the outflow tract. In spite of the infrequent occurrence, anomalies of the subvalvular apparatus, such as muscular chords, should be ruled out by thorough transesophageal echocardiography imaging before decision on the therapeutical strategy.

Keywords

hypertrophic obstructive cardiomyopathy - chordae anomaly - systolic anterior motion - mitral valve disease

• References

• 1 Minakata K, Dearani JA, Nishimura RA, Maron BJ, Danielson GK. Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae. J Thorac Cardiovasc Surg 2004; 127 (02) 481-489
• 2 Kotkar KD, Said SM, Dearani JA, Schaff HV. Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience. Ann Cardiothorac Surg 2017; 6 (04) 329-336
• 3 Gunnal SA, Wabale RN, Farooqui MS. Morphological study of chordae tendinae in human cadaveric hearts. Heart Views 2015; 16 (01) 1-12
• 4 Steggerda RC, Damman K, Balt JC, Liebregts M, ten Berg JM, van den Berg MP. Periprocedural complications and long-term outcome after alcohol septal ablation versus surgical myectomy in hypertrophic obstructive cardiomyopathy: a single-center experience. JACC Cardiovasc Interv 2014; 7 (11) 1227-1234
• 5 Quintana E, Sabate-Rotes A, Maleszewski JJ. , et al. Septal myectomy after failed alcohol ablation: Does previous percutaneous intervention compromise outcomes of myectomy?. J Thorac Cardiovasc Surg 2015; 150 (01) 159-67.e1