This is a still-frame of a 2-dimensional echocardiogram in the parasternal long axis view from our patient. Asymmetric septal hypertrophy, or ASH, is evidenced by the septal thickness of more than one and a half times that of the posterior left ventricular wall. The left ventricular cavity, enlarged left atrium, mitral leaflets and the aortic valve are also identified. In the real-time study that follows, note the systolic anterior motion, or SAM, of the mitral valve abutting against the interventricular septum and obstructing the left ventricular outflow tract.
Asymmetrical septum - short axis
This is a still-frame in the parasternal short axis view at the level of the left ventricle. It shows asymmetric septal hypertrophy and a small left ventricular cavity. In the real-time study that follows, note the motion of the interventricular septum is reduced and that of the posterior left ventricular wall increased. Note also the glistening, or speckled, appearance to the interventricular septum, consistent with myocardial fiber disarray.
HOCM - TEE
To help understand the following transesophageal echocardiogram from another patient with hypertrophic obstructive cardiomyopathy, a diagram of the heart is shown in the long axis view at the level of the left ventricle during systole. The markedly hypertrophied septum, left ventricle, left atrium and anteriorly displaced mitral valve leaflets are labeled. In the real-time study that follows, note the systolic anterior motion of the mitral valve as the leaflet tips are placed into the outflow tract. This results in the murmurs of outflow obstruction and mitral regurgitation.
Color flow Doppler - TEE
This is a systolic still-frame of a color flow Doppler transesophageal echocardiogram in the long axis view from the previous patient. The interventricular septum is markedly hypertrophied, the left ventricle and left atrium are identified. In the real-time study that follows, note the blue-green high velocity jet in the left atrium, indicative of mitral regurgitation. Note also a separate blue-green high velocity jet between the anterior leaflet of the mitral valve and and the interventricular septum, indicative of turbulent blood flow from dynamic obstruction of the left ventricular outflow tract.