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MRI of Cardiac Morphology and Function After Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy

¹ Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
² First Department of Internal Medicine, Nippon Medical School, Tokyo 113-8603, Japan.

View larger version (18K): [in a new window]   Fig. 1. —Bar graph shows MRI detection rates of high signal intensity and delayed hyperenhancement in ablated septal wall after percutaneous transluminal septal myocardial ablation in patients with hypertrophic obstructive cardiomyopathy. Black bar represents detection rate for black blood T2-weighted fast spin-echo imaging, and white bar represents detection rate for contrast-enhanced inversion recovery fast gradient-echo imaging. Values at top of bars indicate number of patients whose images showed focal hyperintensity or delayed hyperenhancement of total number of patients who were examined with each technique. Both black blood T2-weighted fast spin-echo and contrast-enhanced inversion recovery fast gradient-echo imaging depicted ablated region clearly. A = Two of three patients who underwent MRI within 4 weeks of ablation showed central hypointense regions in ablated septal wall. B = In two patients, no focal high signals were identified in septal wall, but delayed hyperenhancement was visualized on contrast-enhanced MRI.

View larger version (121K): [in a new window]   Fig. 2A. —56-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Black blood T2-weighted fast spin-echo image obtained before ablation shows hypertrophic septal wall.

View larger version (123K): [in a new window]   Fig. 2B. —56-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Fat-suppressed black blood T2-weighted fast spin-echo (B) and contrast-enhanced inversion recovery fast gradient-echo images (C) obtained 4 weeks after ablation show focal high signal intensity and delayed hyperenhancement in septal wall and central hypointense region is observed in ablated region (arrow, B and C).

View larger version (119K): [in a new window]   Fig. 2C. —56-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Fat-suppressed black blood T2-weighted fast spin-echo (B) and contrast-enhanced inversion recovery fast gradient-echo images (C) obtained 4 weeks after ablation show focal high signal intensity and delayed hyperenhancement in septal wall and central hypointense region is observed in ablated region (arrow, B and C).

View larger version (132K): [in a new window]   Fig. 3A. —80-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Comparison of fat-suppressed black blood T2-weighted fast spin-echo image obtained before ablation (A) with that obtained 12 months after ablation (B) shows that septal wall thickness has decreased, but no signal changes are observed (arrows, B).

View larger version (132K): [in a new window]   Fig. 3B. —80-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Comparison of fat-suppressed black blood T2-weighted fast spin-echo image obtained before ablation (A) with that obtained 12 months after ablation (B) shows that septal wall thickness has decreased, but no signal changes are observed (arrows, B).

View larger version (126K): [in a new window]   Fig. 2D. —56-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Comparison of cine steady-state free precession images obtained at end diastole (D) and end systole (E) in ablated region with those obtained at end diastole (F) and end systole (G) in nonablated region showing reduction of septal wall motion in ablated region (arrows, E).

View larger version (117K): [in a new window]   Fig. 2E. —56-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Comparison of cine steady-state free precession images obtained at end diastole (D) and end systole (E) in ablated region with those obtained at end diastole (F) and end systole (G) in nonablated region showing reduction of septal wall motion in ablated region (arrows, E).

View larger version (133K): [in a new window]   Fig. 2F. —56-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Comparison of cine steady-state free precession images obtained at end diastole (D) and end systole (E) in ablated region with those obtained at end diastole (F) and end systole (G) in nonablated region showing reduction of septal wall motion in ablated region (arrows, E).

View larger version (116K): [in a new window]   Fig. 2G. —56-year-old woman with hypertrophic obstructive cardiomyopathy who underwent percutaneous transluminal septal myocardial ablation. Comparison of cine steady-state free precession images obtained at end diastole (D) and end systole (E) in ablated region with those obtained at end diastole (F) and end systole (G) in nonablated region showing reduction of septal wall motion in ablated region (arrows, E).

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