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.