Our patient's diagnosis has been well defined by the bedside findings and the noninvasive laboratory assessment. The primary reason for cardiac catheterization in a patient with hypertrophic obstructive cardiomyopathy is when it is critical to determine whether ischemic symptoms, such as angina pectoris, might be related to coronary artery disease, rather than just the hypertrophic process itself.
In our sixteen year old patient with no risk factors for coronary artery disease, coronary angiography was deemed to be unnecessary.
Another patient left ventriculography
The following catheterization is from another older patient with hypertrophic obstructive cardiomyopathy, anginal chest pain and risk factors for coronary artery disease. Left ventriculography may not be necessary if left ventricular function has already been well defined by noninvasive imaging techniques, such as echocardiography. It may be contraindicated when the left ventricular end diastolic pressure is markedly elevated or in the presence of renal insufficiency.
Left ventriculogram - RAO view
This patient's coronary arteries were normal. This is a systolic still-frame of a left ventriculogram in the right anterior oblique (RAO) view in this patient. The tip of the pigtail catheter is in the left ventricle, contrast material has been injected into the left ventricle. Note the spade like appearance of the left ventricular cavity due to its near obliteration during systole. In the real-time study that follows, note the hypercontractile state of the left ventricle that is typical of hypertrophic obstructive cardiomyopathy.
Left ventriculogram - LAO view
This is a still-frame of the left ventriculogram in the left anterior oblique (LAO) view in this patient. The aortic sinus of Valsalva, anterior mitral valve leaflet, ventricular septum, as well as the nearly obliterated body of the left ventricular cavity are identified. The bulging septum and the narrow dark line of the anterior mitral leaflet define the borders of the narrowed left ventricular outflow tract. The real-time study follows.
Left heart pressure "pullback"
This is our other patient's left heart pressure "pullback" tracing. It was obtained by placing the catheter retrograde through the aortic valve to near the apex of the left ventricle and then pulling it back into the aorta. Note that the systolic pressure in the body of the left ventricle below the obstruction is approximately 240 mmHg, while recording a lower ventricular end diastolic pressure. Note also that when the catheter is withdrawn further into the LV outflow tract (LVOT) distal to the obstruction, the systolic pressure drops dramatically to approximately 130 mmHg, while still recording a lower LV end diastolic pressure, a finding characteristic of hypertrophic obstructive cardiomyopathy. As the catheter is further withdrawn into the aortic root, note the abrupt rise in diastolic pressure, denoting when the catheter is distal to the aortic valve and recording a systemic arterial blood pressure in the proximal aortic root.