case_images: PMC11269188_01
case_images: Asymmetric LV hypertrophy identified on the parasternal long-axis view using contrast-enhanced echocardiography (A), the anterior leaflet of the MV exhibiting prominent SAM (arrow, B), severe MR observed (C), and high systolic velocity flow in LVOT reached to 5.8 m/s with a corresponding peak PG of 136 mmHg (D).
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case_images: F1
case_images: TEE were both repeated in our hospital and revealed the following (Figure 1): contrast-enhanced echocardiography confirmed the presence of asymmetrical left ventricular hypertrophy, with the thicknesses of the basal and middle segments of the anterior interventricular septum of 23 and 17 mm, respectively. The thicknesses of the basal and middle segments of the posterior interventricular septum were found to be 16 and 19 mm, respectively.
case_images: BMD tip visible on the mid-esophageal long-axis view of TEE (arrow, A). On the transgastric short-axis view, the BMD was shown close to the anterior interventricular septum (arrow, B). After the hypertrophied myocardium was resected, MR reduced to a mild degree (C) and the systolic peak velocity in the LVOT decreased to less than 3 m/s with a corresponding peak PG of 35 mmHg, indicating a favorable outcome (D).
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case_images: F2
case_images: Because conventional SM through an aortotomy was no longer suitable for this patient, owing to his prosthetic AV, after a comprehensive discussion, a novel minimally invasive procedure, named transapical beating-heart septal myectomy (TA-BSM), was performed (Figure 2). The extent of advancement of the BMD was determined using the mid-esophageal LV long-axis view. The orientation of the resection was identified on the transgastric short-axis view at the basal level (Figure 2).
case_images: Myocardial tissue following 13 resections.
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case_images: F3
case_images: A total of 7.8 g of the hypertrophied myocardium after 13 resections was successfully resected (Figure 3).
case_images: Upon a 7-month follow-up after surgery, the patient's septal thickness was notably thinner using contrast-enhanced echocardiography (A). SAM was no longer present (arrow, B). Only minimal MR remained (C). Systolic peak velocity in the LVOT decreased to 2.6 m/s with a corresponding peak PG of 28 mmHg, indicating a positive surgical outcome (D).
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case_images: F4
case_images: Seven months later, the patient was found to be in good health, with an LVOT peak PG of 28 mmHg (Figure 4) and no recurrence of the hematuria.