090H HOCM and Anomalous Origin of RCA from LCA Sinus

Symptoms

  •  complaining of dyspnea on exertion, fatigue,
  • decreased exercise tolerance.
  • 7 years ago.
    • s/p DES x 2 to LCX
  • echocardiographic evidence of HCM associated with
    • chordal SAM and significant
    • LVOT gradient.  137 mmHg;
    • peak velocity of his MR is 8.4 m/s,
    • corresponding to at least a LV systolic pressure of 283 mmHg.
  • MRI 4 years ago
    • 1.The LV is normal in size.
    • symmetrical LV hypertrophy with
    • slightly more prominent thickening at the base antero-septal wall.
    • 60M HOCM
      Concentric Hypertrophy
      Anomalous RCA from LCA
      Ashley Davidoff
      thecommonvein.net
      60M HOCM
      Concentric Hypertrophy
      Anomalous RCA from LCA
      Ashley Davidoff
      thecommonvein.net
      • maximal wall thickness is 16 mm
      • normal left ventricle
      • LVEF: 67 %.
  • SAM
        • flow acceleration through LVOT in systole with
        • systolic anterior motion of the anterior mitral valve leaflet
        • mild to moderate MR.
    • 60M HOCM
      Diastole – Mitral valve wide open Concentric Hypertrophy
      Anomalous RCA from LCA
      Ashley Davidoff
      thecommonvein.net
      60M HOCM
      Early Systole , LVOT open,  Concentric Hypertrophy
      Anomalous RCA from LCA
      Ashley Davidoff  thecommonvein.net

      60M HOCM
      Peak Systole, LVOT narrowed by systolic anterior motion of the mitral valve with associated mitral regurgitation – Concentric Hypertrophy
      Anomalous RCA from LCA
      Ashley Davidoff  thecommonvein.net
    • LGE  diffuse intermediate intensity signal of late gadolinium
      enhancement

      • sub-endocardium and mid-endocardium layer
        • basal anterior wall,
        • basal lateral wall and
        • basal inferior wall with
        • scattered high intensity foci in the base anterior wall
          • suggestive of fibrosis
          • consistent with hypertrophic cardiomyopathy.
          • 60M HOCM
            LGE – sub-endocardium and mid-endocardium layer , basal anterior wall,
            Ashley Davidoff  thecommonvein.net
            60M HOCM
            LGE – sub-endocardium and mid-endocardium layer , basal anterior wall,
            Ashley Davidoff  thecommonvein.net

            60M HOCM
            LGE – sub-endocardium and mid-endocardium layer , basal anterior wall,
            Ashley Davidoff
            thecommonvein.net
  • s/p recent coronary angiography in 3years ago
    • clean coronaries with
    • patent stent as well as
    • anomalous RCA arising from his LMCA.
  • s/p CTA 3 years ago
    • non-obstructive CAD and
    • anomalous origin of RCA with acute angle at takeoff
    • interarterial course.
    • preserved global systolic LV function.
    • 60M HOCM Anomalous Origin of the Right Coronary Artery From the Left Coronary Artery Sinus
      Ashley Davidoff
      thecommonvein.net