Figure 1. Interventricular Septal Ablation in Patients with
HOCM
(A) CMR end-diastolic long-axis image demonstrates a significant
hypertrophy in basal septum. (B) Display of the 16 myocardial segments
on a circumferential polar plot. the recommended nomenclature for
tomographic imaging of the heart: 1. basal anterior, 2. basal
anteroseptal, 3. basal inferoseptal, 4. basal inferior, 5. basal
inferolateral, 6. basal anterolateral, 7. mid anterior, 8. mid
anteroseptal, 9. mid inferoseptal, 10. mid inferior, 11. mid
inferolateral, mid anterolateral, 13. apical anterior, 14. apical
septal, 15. apical inferior, 16. apical lateral. (C) The circumferential
polar plot presents a limited hypertrophy in basal anteroseptal and
inferoseptal segments. The number indicates the average thickness of
each segment. (D) Right anterior oblique (RAO) projection of the CARTO
shell. Left ventricular (green), aorta (purple), SAM area of
hypertrophic septum (pink) and left bundle branch (yellow) are
presented. Ablation is performed on SAM area (red). (E) Significant
tissue edema can be observed on the live ICE screen. (F) Reduction of
obstruction at rest is seen on continuous-wave Doppler echocardiography.
the LVOT gradient (in mmHg) is significantly decreased after six months
follow up. (P=0.001) LA, left atrium; LV, left ventricle; LVOT, left
ventricular outflow tract; RV, right ventricle; IVS, interventricular
septum.
Figure 2. Morphologic Abnormalities of Mitral Valve
Contributing to Outflow Tract Obstruction
(A, B) The length of the AML was measured in diastole on the apical
three-chamber view. (C) Extraordinarily long anterior mitral valve
leaflet on CMR (D) On live ICE screen, the AML (white arrow) is reflexed
and attached to IVS during systole and pats on the ablation catheter tip
during procedure. AML, anterior mitral leaflet.
Figure 3. Morphologic Abnormalities of Papillary Muscle
(PM) Contributing to Outflow Tract Obstruction (A: normal; B: abnormal)
(A, B) Hypertrophied and apically displaced papillary muscle (white
arrows) with superior head (yellow arrow) in close proximity to the
bulged septum, positioning mitral valve plane toward ventricular septum
compared with normal positioned PM (B). (C, D) CMR end-systolic image
presents a severely narrowed LV cavity (D) in patient with hypertrophied
papillary muscle, as compared with a relatively normal papillary muscle
object (C).
Figure 4. Different patterns of septum hypertrophy
among patients
Patient No.12: B, D, F, H. Patient No.14: A, C, E, G. (A, B) CMR
End-Diastolic Images Demonstrating Different Patterns of
Interventricular Septum Hypertrophy. The distribution of LV hypertrophy
is limited (basal anteroseptal segment) in (A), while diffused (basal,
mid anteroseptal, and mid inferoseptal segments) in (B). (C, D)
Short-axis view presents a segmental LV hypertrophy of the basal
anterior septum in both patients. (E, F) Both mid anteroseptal and
inferoseptal segments present hypertrophied phenotype in (E), but
neither in (F). (G, H) Apical septal segment is free of hypertrophy in
both patients.
Figure 5. The Change of Hemodynamic and Health-related
Quality of Life after 6 months follow up
(A) LVOT gradient is shown (in mmHg) before, 1 month after, 3 months
after and 6 months after LV septal radiofrequency ablation. Reduction of
gradient is significant after 6 months follow up (p<0.001)
especially in patient 3, 4, 8, 14, 15, 16. (B) comparison of
health-related quality of life before and 6 months after ablation
procedure. The score of four dimensions (physical functioning,
role-physical, general health and reported health transition) are
increased after 6 months follow up.