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Tiemuerniyazi X, Chen L, Song Y, Zhao W, Feng W. Clinical Outcomes After the Surgical Treatment of Hypertrophic Obstructive Cardiomyopathy With Left Ventricular Apical Aneurysm. Heart Lung Circ 2023; 32:1122-1127. [PMID: 37355430 DOI: 10.1016/j.hlc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 04/12/2023] [Accepted: 05/06/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Left ventricular apical aneurysm (LVAA) is a rare complication of hypertrophic obstructive cardiomyopathy (HOCM). This study aimed to illustrate the clinical characteristics and surgical outcomes of these patients. METHOD Patients with HOCM and LVAA who underwent modified extended Morrow myectomy and surgical left ventricular reconstruction (SLVR) between October 2012 and March 2021 were retrospectively recruited. Patients with coronary artery disease were excluded. Clinical characteristics were summarised. Time-to-event outcomes were calculated using the Kaplan-Meier method and compared by a log-rank test. RESULTS Fifteen eligible patients were identified; the mean age was 39.9±17.2 years and 40.0% of them were female. All patients had dyspnoea, 46.7% presented with syncope and/or chest pain, and 13.3% had a family history of hypertrophic cardiomyopathy. The mean LVAA size was 36.9±12.3 mm in length and 28.5±11.3 mm in width. Echocardiography showed LV outflow tract obstruction in seven (46.7%) patients, mid-cavity LV obstruction in 12 (80.0%), while systolic anterior motion (SAM) was seen in seven (46.7%). The symptoms were resolved in all patients postoperatively. During a median follow-up of 22.0 months, one (6.7%) patient had sudden cardiac death, one (6.7%) had a haemorrhagic stroke, and the LVAA recurrence was 40.0%. Subgroup analysis showed that signs of SAM and larger LVAA (≥30 mm) were associated with an increased tendency for a longer hospital stay. CONCLUSIONS Patients with HOCM and LVAA present with high-risk profiles. Modified extended Morrow myectomy combined with SLVR is useful in relieving the symptoms and improving the prognosis, although there might be recurrent LVAA.
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Affiliation(s)
- Xieraili Tiemuerniyazi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liangcai Chen
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangwu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Papanastasiou CA, Zegkos T, Karamitsos TD, Rowin EJ, Maron MS, Parcharidou D, Kokkinidis DG, Karvounis H, Rimoldi O, Maron BJ, Efthimiadis GK. Prognostic role of left ventricular apical aneurysm in hypertrophic cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol 2021; 332:127-132. [PMID: 33794232 DOI: 10.1016/j.ijcard.2021.03.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to systematically review and quantitatively synthesize existing evidence about the prognostic value of LV apical aneurysm in patients with HCM. BACKGROUND Hypertrophic cardiomyopathy (HCM) represents a common inherited heart disease associated with enormous diversity in morphologic expression and clinical course. With the increasing penetration of advanced high resolution cardiovascular imaging into routine HCM practice, a subset of HCM patients with left ventricular (LV) apical aneurysm have become more widely recognized. METHODS Medline was searched for studies describing the prognostic implication of LV apical aneurysm in patients with HCM. In the main analysis the combined endpoint of major HCM-related outcomes was assessed. Separate analyses for sudden cardiac death (SCD) events and thromboembolic events were also performed. RESULTS Six studies comprising of 2382 patients met the inclusion criteria. In the pooled analysis, the presence of LV apical aneurysm was significantly associated with major adverse outcomes (pooled OR: 5.13, 95 CI: 2.85 to 9.23, I2:31%), increased risk of SCD arrhythmic events (pooled OR: 4.67, 95% CI: 2.30 to 9.48, I2: 38%) and thromboembolic events (pooled OR: 6.30, 95% CI: 1.52 to 26.19, I2: 66%). CONCLUSIONS These data demonstrate that LV apical aneurysm in HCM patients is associated with an increased risk for SCD events and thromboembolism. This finding might encourage the inclusion of LV apical aneurysm into the HCM SCD risk stratification algorithm as a novel risk marker that supports consideration for primary prevention implantable cardioverter defibrillator and anticoagulation for stroke prophylaxis.
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Affiliation(s)
- Christos A Papanastasiou
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Thomas Zegkos
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece.
| | - Theodoros D Karamitsos
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Ethan J Rowin
- Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, Boston, MA, United States of America
| | - Martin S Maron
- Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, Boston, MA, United States of America
| | - Despoina Parcharidou
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Department of Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT, United States of America
| | - Haralambos Karvounis
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - Ornella Rimoldi
- CNR IBFM, Segrate, Italy; Ospedale San Raffaele, Milano, Italy
| | - Barry J Maron
- Hypertrophic Cardiomyopathy Center and Research Institute, Division of Cardiology, Tufts Medical Center, Boston, MA, United States of America
| | - Georgios K Efthimiadis
- Center of Cardiomyopathies and Inherited Cardiac Diseases, 1st Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
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3
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Efthimiadis G, Zegkos T, Parcharidou D, Ntelios D, Panagiotidis T, Gossios T, Karvounis H. A simple algorithm for a clinical step-by-step approach in the management of hypertrophic cardiomyopathy. Future Cardiol 2021; 17:1395-1405. [PMID: 33615852 DOI: 10.2217/fca-2020-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease with an autosomal dominant pattern and a reported prevalence of about 0.2%. In this review, we present a simple algorithm for the management of first diagnosed HCM patients. Initially, the clinical examination, medical and detailed family history and the ECG are essential. The etiological diagnosis of left ventricular hypertrophy is important in order to differentiate HCM due to sarcomeric genes mutation from other phenocopies, such as cardiac amyloidosis. The next step consists of the cardiovascular imaging and ambulatory electrocardiography. Cardiopulmonary exercise testing may also be considered if available. All of the above provide evidence for the critical step of the risk stratification of patients for sudden cardiac death. The therapeutic strategy, with respect to obstructive and nonobstructive disease, arrhythmias and end-stage HCM is also described.
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Affiliation(s)
- Georgios Efthimiadis
- 1st Cardiology department, Laboratory of Cardiomyopathies and Inherited Cardiac Diseases, AHEPA University hospital, Thessaloniki 54636, Greece
| | - Thomas Zegkos
- 1 Cardiology department, Laboratory of Cardiomyopathies and Inherited Cardiac Diseases, AHEPA University hospital, Thessaloniki 54636, Greece
| | - Despoina Parcharidou
- 1 Cardiology department, Laboratory of Cardiomyopathies and Inherited Cardiac Diseases, AHEPA University hospital, Thessaloniki 54636, Greece
| | - Dimitris Ntelios
- 1 Cardiology department, Laboratory of Cardiomyopathies and Inherited Cardiac Diseases, AHEPA University hospital, Thessaloniki 54636, Greece
| | - Theofilos Panagiotidis
- 1 Cardiology department, Laboratory of Cardiomyopathies and Inherited Cardiac Diseases, AHEPA University hospital, Thessaloniki 54636, Greece
| | - Thomas Gossios
- Barts Heart Centre, St Bartholomew's Hospital, W Smithfield, London, EC1A 7BE, UK
| | - Haralambos Karvounis
- 1 Cardiology department, Laboratory of Cardiomyopathies and Inherited Cardiac Diseases, AHEPA University hospital, Thessaloniki 54636, Greece
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Cui L, Tse G, Zhao Z, Bazoukis G, Letsas KP, Korantzopoulos P, Roever L, Li G, Liu T. Mid-ventricular obstructive hypertrophic cardiomyopathy with apical aneurysm: An important subtype of arrhythmogenic cardiomyopathy. Ann Noninvasive Electrocardiol 2019; 24:e12638. [PMID: 30737990 DOI: 10.1111/anec.12638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 06/11/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023] Open
Abstract
Mid-ventricular obstructive hypertrophic cardiomyopathy (MVOHCM) is an uncommon type of HCM. LV apical aneurysms are present in more than 20% MVOHCM cases and has been identified as an independent predictor of potentially lethal arrhythmic events, including non-sustained or sustained ventricular tachycardia (VT), and ventricular fibrillation (VF), as well as SCD. Although the pathogenesis of LVA remains unknown, but it has been suggested that apical aneurysm may be secondary to the increased after-load and high apical pressure arising from significant pressure gradient of the midventricular obstruction. The scarred rim of the aneurysm and the adjacent areas of LV myocardial fibrosis and consequent apical oxygen-demand mismatch may be responsible for the formation of apical aneurysm. Recent electrophysiologic studies have demonstrated that the aneurysmal rim forms the primary culprit arrhythmogenic substrate for generation of monomorphic ventricular tachycardia leading to SCD, but the clinical significance of the size of aneurysm in relation to SCD remains unsettled. We summarized the clinical features of the patients with MVOHCM and apical aneurysms. Appropriate therapeutic interventions include ICD implantation, and early surgical intervention for gradient relief may be undertaken to relief the MVO.
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Affiliation(s)
- Li Cui
- Department of Cardiology, Tianjin People's Hospital, Tianjin, 300120, People's Republic of China
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Zhiqiang Zhao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Brazil
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, People's Republic of China
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Malcolmson JW, Hamshere SM, Joshi A, O'Mahony C, Dhinoja M, Petersen SE, Sekhri N, Mohiddin SA. Doppler echocardiography underestimates the prevalence and magnitude of mid-cavity obstruction in patients with symptomatic hypertrophic cardiomyopathy. Catheter Cardiovasc Interv 2018; 91:783-789. [PMID: 28766836 DOI: 10.1002/ccd.27143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/04/2017] [Accepted: 05/03/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate utility of Doppler echocardiography in the assessment of left ventricular (LV) mid-cavity obstructive (LVMCO) hypertrophic cardiomyopathy (HCM). BACKGROUND LVMCO is a relatively under-diagnosed complication of HCM and may occur alone or in combination with LV outflow tract obstruction (LVOTO). Identifying and quantifying LVMCO and differentiating it from LVOTO has important implications for patient management. We aimed to assess diagnostic performance of Doppler echocardiography in the assessment of suspected LV obstruction. METHODS Forty symptomatic HCM patients with suspected obstruction underwent cardiac catheterization, and comparison of location and magnitude of Doppler derived gradients with synchronous invasive measurements (reference standard), at rest and isoprenaline stress (IS). RESULTS Doppler's diagnostic accuracy for any obstruction (≥30 mmHg) in this cohort was 75% with false positive and false negative rates of 2.5 and 22.5%, respectively. During subanalysis, Doppler's diagnostic accuracy for isolated LVOTO in this selected cohort is 83% with false positive and false negative rates of 4 and 12.5%, respectively. For LVMCO, the accuracy is only 50%, with false positive and false negative rates of 10 and 40%, respectively. Doppler gradients for isolated LVOTO were similar to invasive: 85 ± 51 and 87 ± 35 mmHg, respectively (P = 0.77). Doppler gradients in LVMCO were consistently lower than invasive: 45 ± 38 and 81 ± 31 mmHg, respectively (P = 0.0002). Mid-systolic flow cessation and/or contamination of spectral signals were identified as causes of Doppler-derived inaccuracies. CONCLUSIONS Doppler echocardiography under-diagnoses and underestimates severity of LVMCO in symptomatic HCM patients. Recognition of abrupt mid-systolic flow cessation and invasive measurements may improve detection of LVMCO in HCM.
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Affiliation(s)
- James W Malcolmson
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom
| | - Stephen M Hamshere
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Abhishek Joshi
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Constantinos O'Mahony
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, Gower St, London WC1E, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom
| | - Steffen E Petersen
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, United Kingdom.,NIHR Biomedical Research Unit at Barts, London, United Kingdom
| | - Neha Sekhri
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom
| | - Saidi A Mohiddin
- Barts Heart Centre, Barts Health NHS Trust, Whitechapel, London E1 1BB, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, United Kingdom.,NIHR Biomedical Research Unit at Barts, London, United Kingdom
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Phenotypic overlap in hypertrophic cardiomyopathy: Apical hypertrophy, midventricular obstruction, and apical aneurysm. J Cardiol 2014; 64:463-9. [DOI: 10.1016/j.jjcc.2014.03.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/19/2014] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
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7
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Pastore CA, Samesima N, Pereira Filho HG, Varoni LPC, Rochitte CE, Vieira ML, Ávila LFRD, Melo RDJL, Pereira ADC, Daheer J, Carlo CHD. Rare Association: Chagas' Disease and Hypertrophic Cardiomyopathy. Ann Noninvasive Electrocardiol 2014; 20:498-501. [PMID: 25367861 DOI: 10.1111/anec.12229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A woman (49 years) with Chagas' disease showed: ECG, right bundle-branch block and left anterior-superior fascicular block; V1 has unusual R > R', and elevated ST segment from V2 to V6 . Additional imaging revealed concomitant HCM and Chagas, which is uncommon. Overlapping of ECG findings can be explained by this rare association of diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlos Henrique del Carlo
- Day Hospital Unit, Heart Institute (InCor), Medical School Hospital, University of São Paulo, São Paulo, Brazil
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8
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Petrou E, Kyrzopoulos S, Sbarouni E, Tsiapras D, Voudris V. Mid-ventricular hypertrophic obstructive cardiomyopathy complicated by an apical aneurysm, presenting as ventricular tachycardia. J Cardiovasc Ultrasound 2014; 22:158-9. [PMID: 25309696 PMCID: PMC4192417 DOI: 10.4250/jcu.2014.22.3.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/04/2014] [Accepted: 08/20/2014] [Indexed: 11/22/2022] Open
Affiliation(s)
- Emmanouil Petrou
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - Eftychia Sbarouni
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitris Tsiapras
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Vassilis Voudris
- Division of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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9
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Efthimiadis GK, Pagourelias ED, Gossios T, Zegkos T. Hypertrophic cardiomyopathy in 2013: Current speculations and future perspectives. World J Cardiol 2014; 6:26-37. [PMID: 24575171 PMCID: PMC3935059 DOI: 10.4330/wjc.v6.i2.26] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/04/2013] [Accepted: 01/14/2014] [Indexed: 02/06/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM), the most variable cardiac disease in terms of phenotypic presentation and clinical outcome, represents the most common inherited cardiomyopathic process with an autosomal dominant trait of inheritance. To date, more than 1400 mutations of myofilament proteins associated with the disease have been identified, most of them “private” ones. This striking allelic and locus heterogeneity of the disease certainly complicates the establishment of phenotype-genotype correlations. Additionally, topics pertaining to patients’ everyday lives, such as sudden cardiac death (SCD) risk stratification and prevention, along with disease prognosis, are grossly related to the genetic variation of HCM. This review incorporates contemporary research findings and addresses major aspects of HCM, including preclinical diagnosis, genetic analysis, left ventricular outflow tract obstruction and SCD. More specifically, the spectrum of genetic analysis, the selection of the best method for obstruction alleviation and the need for a unique and accurate factor for SCD risk stratification are only some of the controversial HCM issues discussed. Additionally, future perspectives concerning HCM and myocardial ischemia, as well as atrial fibrillation, are discussed. Rather than enumerating clinical studies and guidelines, challenging problems concerning the disease are critically appraised by this review, highlighting current speculations and recommending future directions.
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Jung HC, Moon KW, Kim HW, Kim JH, Yoo KD, Kim CM. Pressure Tracings in Hypertrophic Cardiomyopathy With Dynamic Midventricular Obstruction. Korean Circ J 2012; 42:220-1. [PMID: 22493621 PMCID: PMC3318098 DOI: 10.4070/kcj.2012.42.3.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 09/09/2011] [Accepted: 09/23/2011] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hee-Chan Jung
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Keon-Woong Moon
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Hyung-Woo Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Ji-Hoon Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Ki-Dong Yoo
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
| | - Chul-Min Kim
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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Left ventricular apical aneurysm in hypertrophic cardiomyopathy. COR ET VASA 2011. [DOI: 10.33678/cor.2011.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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