Aim of this case-series report is to elucidate the potential role of contrast echocardiography (C-Echo) to optimize and improve the study of patients with Hypertrophic Cardiomyopathy (HCM).
However, this report is also aimed to demonstrate the role of C-Echo in excluding a HCM diagnosis.
Case 1.
A young male patient, 27 y-o, presented to our Emergency Department (ED) because of chest pain and dyspnea. He referred a diagnosis of HCM without LVOT obstruction.
Trans-Thoracic Echocardiogram (TTE) demonstrate a severe hypertrophy of interventricular septum with a maximum diastolic thickness of 25 mm. There was no a significant LVOT gradient.
Contrast enhanced echocardiography, by left ventricle opacification (LVO) (Sonovue, Bracco Imaging, Milan, Italy), demonstrated:
an interventricular septum thickness of 32 mm (7 mm more than TTE measurement);
a clear touching of mid-ventricular walls with a max systolic gradient of 40 mmHg (figure 1). This aspect was no clearly detectable by TTE alone.
Case 2.
A young male patient, 31 y-o, presented to our ED because of palpitations.
At 12-leads ECG he presented a sinus rhythm with frequent monomorphic premature ventricular complexes (PVC).
A TTE was performed. It put a suspicion of left ventricle (LV) APICAL HCM, because of an apical diastolic thickness of 26 mm.
A contrast enhanced echocardiography by LVO (Sonovue, Bracco Imaging, Milan, Italy) was planned.
It allowed to excluding a HCM by demonstrating a LV apical false tendon mimicking endocardial border (figure 2).
LV false tendons are fibromuscular bands that traverse LV cavity and are generally considered to be benign. Thay may also contain conduction tissue (Purkinje fibers) and have been identified as a source of ventricular arrhythmias. They are most commonly located near the LV apex.
Conclusion.
It is possible to conclude that, by LV cavity opaciļ¬cation optimization of echocardiographic planes and views, C-Echo represents a suitable tool for: 1) a more accurate LV wall thickness (WT) measurement; 2) acquiring additional informations about intraventricular gradients in patients with HCM. In addition, C-Echo allows to exclude a HCM diagnosis in presence of LV apical false tendons.