Hypertrophy

Case of biventricular hypertrophy and biventricular failure. Hypertrophy often indicates some degree of diastolic dysfunction with altered filling properties and compliance of the ventricles. As such, these patients are susceptible to increased heart rate, during which the filling time is impaired.

Please refer to our learning module on LV mass (PDF)

Case of a newborn with biventricular hypertrophy and biventricular dysfunction (systolic)

Sweep in parasternal long axis outlining that the aortic and pulmonary valve are opening and closing (no atresia - anatomical or functional)

Parasternal short axis outlining the biventricular hypertrophy. The RV seems to be "rocking" and with poor systolic contraction. The septum is dyskinetic with paradoxical movements. The LV free wall also appears to have areas of regional dysfunction.

Case of LV hypertrophy

In this patient, there is systolic anterior motion of the mitral valve - an indicator of LV hypertrophy. There is intra-cavitary acceleration of flow by colour. There is mitral regurgitation. The estimated peak LV pressure in systole is up to 84 mmHg by CW-Doppler.

LV hypertrophy in parasternal long axis with septal hypertrophy

Some degree of systolic anterior motion of the mitral valve. Septal hypertrophy.

Some dynamic obstruction secondary to the septal hypertrophy

Intra-cavitary acceleration with mitral insufficiency.

CW-Doppler estimating the peak systolic LV pressure by mitral insufficiency and capturing some of the intra-cavitary acceleration.

Mitral insufficiency - possibly secondary to the distortion of the mitral apparatus due to the LV hypertrophy. One may also appreciate some degree of RV hypertrophy.

Case of a newborn on high dose steroids who developed biventricular hypertrophy

Short axis with significant circumferential hypertrophy of the LV, as well as some hypertrophy of the papillary muscles

Parasternal long axis outlining LV hypertrophy and septal hypertrophy.

3D volumes showing circumferential hypertrophy

Acceleration in the LV outflow tract (dynamic sub-aortic acceleration from the septal hypertrophy). There is pseudo (incomplete) systolic anterior motion of the mitral valve. There is also some degree of RV hypertrophy.

Tilted 4 chamber view to evaluate the LVOT with a posterior sweep showing that the papillary muscles are hypertrophied.

Nyquist (velocity filter) at 148 cm/s. Less aliasing but still some subjective acceleration at the LVOT. The LVOT is narrowed from the dynamic contraction of the septum and some degree of pseudo-SAM (systolic anterior motion of mitral valve).

Focus and zoom on the LVOT

LVOT view. Filling seems preserved in diastole.

Intracavitary acceleration at a Nyquist of 92.4 cm/s.

Intra-cavitary acceleration with some degree of mild miltral insufficiency.

The RV hypertrophy is appreciated in this tilted 4 chamber view with some RV focus.

Parasternal long axis. One with a zoom on the LVOT / Aortic valve. The other one with colour showing some mitral regurgitation.

Parasternal long axis. One with a zoom on the LVOT / Aortic valve. The other one with colour showing some mitral regurgitation. One may also appreciate some degree of RVOT free wall hypertrophy.

Some images below (frozen) showing some pseudo-systolic anterior motion of the mitral valve, associated with mitral regurgitation and some acceleration in the left ventricular outflow tract.

Case of severe hypertrophic cardiomyopathy

Significant hypertrophy appreciated from the parasternal long axis view. The hypertrophy is septal and at the level of the LV free wall. The LV cavity is almost completely obliterated.

Colour clips indicating acceleration of flow in the out flow tract.

Seep in the parasternal long axis with colour. The RV may be seen with some degree of hypertrophy and filling by colour.

Parasternal short axis view outlining the significant hypertrophy.

Another sweep in the parasternal short axis view. The Aortic valve may be seen. It seems to open and close and be tri-leaflet.

Significant hypertrophy observed in the apical 4 chamber view. There is "kissing" ventricular walls.

There is mitral insufficiency by colour flow.

Acceleration of flow at the level of the LV outflow tract. There is filling of the aorta with flow that seems to originate from below the valve (not retrograde from the ductus)

There is some degree of RV hypertrophy with some tricuspid insufficiency and intra-cavitary acceleration by colour (although the Nyquist is at 61 cm/s)

This view outlines well the biventricular hypertrophy with the significant septal hypertrophy.

Subcostal view.

Subcostal short axis view. Outlining the RVOT with flow through the pulmonary valve.

Flow may be seen in the descending aorta.

Inflow PW-Doppler.

M-Mode in the parasternal long axis view outlining the significant hypertrophy of the septum and the posterior wall.

LV Intra-cavitary peak gradient of at least 81 mmHg estimated by CW-Doppler

RV Intra-cavitary peak gradient of at least 33 mmHg estimated by CW-Doppler

TR of 37 by CW-Doppler

Measurement of the septum by 2D (B-mode) Echocardiography

Case of septal hypertrophy in the context of infant of diabetic mother

Parasternal long axis outlining the biventricular hypertrophy, with some septal hypertrophy.

Parasternal short axis outlining the biventricular hypertrophy, with some septal hypertrophy. There is flattening of the interventricular septum at the peak of systole.

Apical 4 chamber view. There is subjective paradoxical movement of the septum, although this view is not the most optimal to appreciate that.

Colour box outlines the tricuspid regurgitant jet. There is also flow going through the LVOT to the aorta.

5 chamber view (tilted)

The patent ductus arteriosus is bidirectional, right to left in systole.

Inter-atrial communications that are mainly left to right.

Subcostal view. one may appreciate that the blood flow is going through the aortic valve to the ascending aorta, at the level of the LVOT.

Created by Gabriel Altit - Neonatologist / Créé par Gabriel Altit (néonatalogiste) - © NeoCardioLab - 2020-2022 - Contact us / Contactez-nous