CASE
A 78-year-old woman with histories of apical hypertrophic cardiomyopathy (ApHCM), chronic atrial fibrillation (AF), and cerebral infarction were referred to our hospital for chronic heart failure. The transthoracic echocardiography revealed severely dilated right and left atrium and severe mitral valve regurgitation (MR) with preserved ejection fraction (Fig1). The transthoracic echocardiography and left ventriculography showed the left ventricular apical hypertrophy with a left ventricular apical aneurysm (LVAA) (Fig.2, Fig3). The patient was diagnosed as severe atrial functional MR. She underwent mitral valve replacement, left appendage resection, and LVAA resection (Fig.4). Histopathological examination of the LVAA revealed the thick fibrosis and stretched myocardial cells (Fig.5A, 5B).
LVAA forms in 10%-30% of cases of ApHCM due to increased left ventricular apical pressure [1]. Since LVAA can cause thrombosis, fatal arrhythmias, and heart failure, ApHCM with LAVV has a higher mortality rate, requiring pharmacologic or surgical treatment for its complications [2]. ApHCM is also known to cause AF due to left ventricular diastolic dysfunction. We experienced a rare case of atrial functional severe MR due to AF secondary to ApHCM and LVAA. Although it was unclear whether the LVAA was symptomatic, it was appropriate to perform simultaneous LVAA resection to prevent LVAA related complications.