J Korean Soc Echocardiogr.  1994 Jul;2(1):88-95. 10.4250/jkse.1994.2.1.88.

2 Cases of Apical Hypertrophic Cardiomyopathy with Left Ventricular Endomyocardial Calcification

• Park JC
• Cho IJ
• Seo JP
• Ryu MH
• Lee MK
• Park JS
• Gill GC
• Park JH
• Jeong MH
• Cho JG
• Kang JC

• KMID: 2410464
• DOI: http://doi.org/10.4250/jkse.1994.2.1.88

Abstract

Calcification of myocardium is most common in the site of an old infarction or in an aneurysmal wall. In addition, Myocardial calcification may occur in association with endomyocardial fibrosis and hyperparathyroidism, as a result of focal toxic or inflammatory myocardial necrosis, as well as in patients undergoing hemodialysis. Calcium deposits due to parasites and due to neoplastic disease may also be seen, But, left ventricular endomyocardial calcification associated with apical hypertrophic cardiomyopathy is very rare. This report describes 2 cases of apical hypertrophic cardiomyopathy with left ventricular endomyocardial calcification, diagnosed by the echocardiographic, angiographic and histologic findings.

Keyword

Apical hypertrophic cardiomyopathy; Endomyocardial calcification

MeSH Terms

Aneurysm
Calcium
Cardiomyopathy, Hypertrophic*
Echocardiography
Endomyocardial Fibrosis
Humans
Hyperparathyroidism
Infarction
Myocardium
Necrosis
Parasites
Renal Dialysis
Calcium

Figure

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  Fig. 1. Chest roentgenogram(A) and fluoroscopy(B) show curvilinear calcification within the heart shadow.

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  Fig. 2. The ECG shows LVH with strain and giant negative T waves in V4–6.

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  Fig. 3. Two-dimensional echocardiogram of the patient in the parasternal long axis view(A) and apical 4 chamber view(B). LV apex is markedly thickend and echogenic materials are scattered around the inner surface of LV apex.

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  Fig. 4. The T1–201 image, transaxial view shows increased uptake in the LV apex.

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  Fig. 5. Cardiac MRI shows signal void lesion in inner surface of LV apex.

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  Fig. 6. Left ventriculogram(RAO view) shows globular shape of LV cavity during systole(A: systole, B: diastole).

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  Fig. 7. The ECG shows LVH with strain and giant negative T waves in V3–6.

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  Fig. 8. Two-dimensional echocardiogram of the patient in the parasternal long axis view(A) and apical 4 chamber view(B). LV wall thickness is markedly increased toward the apex and echogenic materials are scattered around the innner surface of LV apex.

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  Fig. 9. The T1–201 image, transaxial view shows increased uptake in the LV apex.

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  Fig. 10. Left ventriculogram(RAO view) shows globular shape of LV cavity during systole(A: systole. B: diastole).

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  Fig. 11. Myocytes are surrounded by slightly increased interstitial fibrous tissue(hematoxylm-eosin. ×150).

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  Fig. 12. Two myocytes(M) are separated by intervening collagenous fibrous tissue(C). A few attenuated cytoplasmic processes of fibroblasts(F) are seen. Some mitochondina in the myocytes undergo degenercetive fatty changes(arrow)× 24,000).

Reference

References

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