Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Case Report
Left Ventricular Outflow Tract Obstruction Due to Anomalous Insertion of Papillary Muscle
Tetsuya NomuraYoshiaki HaradaYoko SuzakiHironori HayashiHiroyuki TanakaJun ShiraishiSumio KomatsuYasuo HosomiShinji HiranoHitoshi YakuNobuo Kitamura
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2004 Volume 68 Issue 12 Pages 1219-1222

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Abstract

A 56-year-old man who complained of quadrantic hemianopsia was admitted to determine its etiology. Cerebral angiography revealed no organic stenosis. Echocardiography showed clear direct continuity between a hypertrophied anterolateral papillary muscle and the anterior mitral leaflet, and the left ventricular (LV) outflow tract (LVOT) was narrowed by the presence of an accessory papillary muscle. The LVOT obstruction caused an intra-LV pressure overload that resulted in LV concentric hypertrophy. Arrhythmia, such as paroxysmal atrial fibrillation (PAF), was thought to have caused a cerebral embolism. Mitral valve replacement (MVR), septal myectomy, and myectomy of the abnormal papillary muscle were performed, and complete release of the LVOT obstruction was accomplished. Anomalous insertion of papillary muscle is a rare cause of LVOT obstruction. Echocardiography was useful in identifying the papillary muscle malformation, and surgery was completely curative. (Circ J 2004; 68: 1219 -1222)

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© 2004 THE JAPANESE CIRCULATION SOCIETY
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