ASSESSMENT OF APICAL HYPERTROPHIC CARDIOMYOPATHY USING TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Two-dimensional echocardiography is the method of choice for imaging a nd diagnosis in patients with hypertrophic cardiomyopathy. However, ul trasound examination of the left ventricular apex by transthoracic ech ocardiography is often inadequate so that hypertrophy localised to thi s region may be missed. The purpose of this study was to evaluate the use of multiplane transoesophageal echocardiography in the diagnosis a nd assessment of apical hypertrophic cardiomyopathy. Six patients with apical hypertrophic cardiomyopathy underwent transthoracic and multip le transoesophageal echocardiography, Assessment of the proximal left ventricle was possible in all patients by both techniques and normal w all thickness measurements were obtained, Assessment of the distal lef t ventricle by multiple transesophageal echococardiography revealed hy pertrophy of the apex (range 1.7-2.9 cm) and less marked hypertrophy o f the distal segments of the left ventricle in all 6 patients (1.4-2.2 cm). Examination of the papillary muscles was also possible and hyper trophy was detected in 2 patients. By transthoracic echocardiography, hypertrophy was detected in the distal left ventricle of 5 patients an d values were less than those obtained by multiplane transoesophageal echocardiography, No papillary muscle hypertrophy was seen, The apical segment was imaged in only 4 patients and maximum thicknesses of the apical segment were greater by multiple transoesophageal echocardiogra phic examination than by transthoracic echocardiography (mean 2.25 +/- 0.4 and 1.97 +/- 0.3 cm, respectively). We conclude that apical hyper trophic cardiomyopathy may be difficult to diagnose using transthoraci c echocardiography because of inconsistent imaging of the apical segme nt, The distribution of hypertrophy may be inappropriately assigned an d the severity of wall thickening underestimated, Multiplane transoeso phageal echocardiography allows high resolution imaging of all segment s of the left ventricle, particularly the apex.