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Cardiac magnetic resonance in pre-operative management of patients with obstructive hypertrophic cardiomyopathy- a single center experience

Session Poster session 2

Speaker Monica Trofin

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Myocardium
  • Session type : Poster Session

Authors : M Trofin (Bucharest,RO), M Alexandrescu (Bucharest,RO), R Ticulescu (Bucharest,RO), M Greavu (Bucharest,RO), A Fruntelata (Bucharest,RO), L Dorobantu (Bucharest,RO)

M Trofin1 , M Alexandrescu1 , R Ticulescu1 , M Greavu1 , A Fruntelata1 , L Dorobantu1 , 1Monza Hospital , Cardiomyopathy Center - Bucharest - Romania ,

European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii367

Background: Fifty patients were referred to our Center between 2015 and 2018 and all of them received a preoperative CMR. In the present study, we are describing the various phenotypical expressions of HCM, their functional consequences as well as the impact in planning the management of septal myomectomy, using CMR.

Methods and results: We have enrolled 50 consecutive patients between 2015 and 2018 with obstructive HCM, which had an indication to septal myomectomy and we performed a pre-operative CMR. A clinical diagnosis of HCM using standard ECG and echocardiographic criteria was confirmed through CMR. The exclusion criteria of our analysis was prior septal reduction therapy and contraindications to CMR (MR-not conditional ICD). The baseline characteristics of the enrolled patients are described as well as the used CMR-algorithm. An exhaustive analysis of different morphologic aspects observed through cardiac MR as well as the role of LGE-CMR in visualizing the distribution and quantification of fibrosis were assessed. The presence of myocardial crypts and their precise localization, predominantly at the basal posterior septum were noted, in matter to be able to avoid them intraoperative. Also, we analyzed the expression of HCM regarding the papillary muscle morphology. We are also briefly describing the various scenarios in which CMR proved to be an indispensable tool in managing and planning the surgical assessment of the HCM with the technique ‘in one piece myomectomy’.

Conclusion: CMR is a powerful imaging technique by its unique capacity in thoroughly describing the presence and magnitude of LV wall thickness, especially in focal regions, as well as of the myocardial crypts, respectively. Particularly when planning a septal myomectomy with the technique ‘in one piece’, CMR  has proved to be a robust instrument in successful planning the detailed surgical approach.

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