case_images: PMC7303768_01
case_images: Three-chamber view reconstructions from diastolic (A) and systolic (C) phases of an
  electrocardiogram-gated contrast-enhanced cardiac computed tomography demonstrate
  apical-variant hypertrophic cardiomyopathy with apical pouch-aneurysm. Volume-rendered
  reconstructions of the left ventricular blood pool during diastole (B) and systole (D)
  demonstrate obliteration of the mid-ventricular cavity during systole (arrow).
case_images: 10.1177_2324709620934324-fig1.jpg
case_images: PMC7303768_01_10.1177_2324709620934324-fig1.jpg
case_images: fig1-2324709620934324
case_images: On admission, a chest computed tomography with angiography was performed and findings are demonstrated in Figure 1.
case_images: Transthoracic echocardiography: 2-chamber systolic frame (A) showing apical hypertrophy
  with apical aneurysm (pouch) and mid-cavitary obstruction. Parasternal long axis view
  (B) shows left ventricle (LV) apical hypertrophy measuring 20 mm. Two-chamber view of LV
  (C, left) shows "Ace of spades" morphology during systole due to apical hypertrophic
  cardiomyopathy; color Doppler shows mitral regurgitation (C, right). Two-chamber
  systolic view (D) shows apical and mid-cavitary pressure gradient with apical and
  mid-cavitary peak flow of 2, 3 m/s, respectively.
case_images: 10.1177_2324709620934324-fig2.jpg
case_images: PMC7303768_01_10.1177_2324709620934324-fig2.jpg
case_images: fig2-2324709620934324
case_images: The postoperative TTE (Figures 2 and 3) showed a successfully implanted aortic valve prosthesis with a mean gradient of 20 mm Hg across the valve and mild regurgitation.
case_images: Continuous wave spectral Doppler (A) shows 3 signals: mitral regurgitation peak
  velocity (6.1 m/s), mid-cavitary peak velocity (3 m/s), and apical left ventricle peak
  velocity (2 m/s). Polar map of 17 segments strain (B) shows marked reduction (-9.7%)
  with marked apical and mid-segment involvement. Ascending aortic aneurysm with midlevel
  diameter of 48 mm (C).
case_images: 10.1177_2324709620934324-fig3.jpg
case_images: PMC7303768_01_10.1177_2324709620934324-fig3.jpg
case_images: fig3-2324709620934324
case_images: The postoperative TTE (Figures 2 and 3) showed a successfully implanted aortic valve prosthesis with a mean gradient of 20 mm Hg across the valve and mild regurgitation.
case_images: Continuous wave spectral Doppler (3 months postoperatively) shows 3 signals: MR peak
  velocity (6 m/s), mid-cavitary peak velocity (3 m/s), and apical LV peak velocity (2
  m/s).
case_images: 10.1177_2324709620934324-fig4.jpg
case_images: PMC7303768_01_10.1177_2324709620934324-fig4.jpg
case_images: fig4-2324709620934324
case_images: ApHCM with stable apical and mid-cavitary gradients and stable apical pouch (Figures 4 and 5). A follow-up computed tomography done 11 months postoperatively showed stable ascending aortic aneurysm and confirmed the pentad stability (Figure 6; Supplementary material Videos 3 and 4).
case_images: Continuous wave spectral Doppler (11 months postoperatively) shows 3 signals: mitral
  regurgitation peak velocity (5.9 m/s), mid-cavitary peak velocity (2.8 m/s), and apical
  left ventricular peak velocity (2 m/s).
case_images: 10.1177_2324709620934324-fig5.jpg
case_images: PMC7303768_01_10.1177_2324709620934324-fig5.jpg
case_images: fig5-2324709620934324
case_images: ApHCM with stable apical and mid-cavitary gradients and stable apical pouch (Figures 4 and 5). A follow-up computed tomography done 11 months postoperatively showed stable ascending aortic aneurysm and confirmed the pentad stability (Figure 6; Supplementary material Videos 3 and 4).
case_images: Cross-sectional computed tomography angiography of the chest (11 months
  postoperatively) showing stable ascending aortic aneurysm with a diameter of 46.6
  mm.
case_images: 10.1177_2324709620934324-fig6.jpg
case_images: PMC7303768_01_10.1177_2324709620934324-fig6.jpg
case_images: fig6-2324709620934324
case_images: ApHCM with stable apical and mid-cavitary gradients and stable apical pouch (Figures 4 and 5). A follow-up computed tomography done 11 months postoperatively showed stable ascending aortic aneurysm and confirmed the pentad stability (Figure 6; Supplementary material Videos 3 and 4).