mitral valve prolapse and the pickelhaube - asecho.org · lakshmi muthukumarmd, faraazrahman md, m....
TRANSCRIPT
2/12/2018
1
Mitral Valve Prolapseand the
Pickelhaube
Denise Ignatowski, BS, RDCS
Mitral Valve Prolapse
2/12/2018
2
Prevalence11‐13% : General population
Malignant Cases
2/12/2018
3
High Risk features
•Mitral annulus disjunction
• Systolic curling
•Pickelhaube Spike
Mitral annulus disjunctionHypermobility of the MV apparatus
2/12/2018
4
Mitral annulus disjunctionHypermobility of the MV apparatus
Mitral annulus disjunctionParadoxical systolic increase of the
mitral annulus diameter
2/12/2018
5
Mitral annulus disjunctionParadoxical systolic increase of the mitral
annulus diameter
Diastole Systole
Systolic CurlingIncreased myocardial function adjacent
to the prolapsed leaflet
2/12/2018
6
Systolic CurlingFocal hypertrophy of the LV base
Basal to mid LV wall thickness ratio >1.5
Ballerina foot Deformity
2/12/2018
7
APLAX
40 cm/s
2/12/2018
8
Pickelhaube
GermanHelmet
2/12/2018
9
PickelhaubeHigh‐velocity systolic signal with
tissue Doppler imaging resembling the Pickelhaube
Malignant phenotype
The Pickelhaube Sign:
Novel Echocardiographic Risk Marker for Malignant
Mitral Valve Prolapse Syndrome
Lakshmi Muthukumar MD, Faraaz Rahman MD, M. Fuad Jan MBBS MD, Armaan Shaikh DO, Lindsey Kalvin RDCS, Anwer Dhala MD, Arshad Jahangir MD, A. Jamil Tajik MD
2/12/2018
10
“The tugging of the posteromedial papillary muscle in mid‐systole by the myxomatousprolapsing leaflets causes the adjacent posterobasal LV wall to be pulled sharply toward the apex”
2/12/2018
11
> 16 cm/s
Strain Correlation
‐38 %
2/12/2018
12
Strain Bullseye
Postero‐Medial Papillary Muscle
‐38 %
Case #142 y.o. woman
h/o Postpartum Cardiomyopathy, 2009
s/p Single chamber ICD
2/12/2018
13
2/12/2018
14
2/12/2018
15
• Annular Disjunction• Mitral Annular Systolic Increase
• Systolic Curling• Localized hypertrophy
> 20 cm/s
2/12/2018
16
‐ 32 %
Malignant MVP
•Annular Disjunction•Systolic Curling•Pickelhaube‐ Systolic peak > 16 cm/s‐ Exaggerated Strain Value
2/12/2018
17
Case #266 y.o. woman
Visited family practice doctor for neck pain
2/6 systolic murmur
2/12/2018
18
2/12/2018
19
2/12/2018
20
• Annular Disjunction
• Systolic Curling
• Focal hypertrophy
2/12/2018
21
> 20 cm/s
2/12/2018
22
‐ 41 %
2/12/2018
23
THANK YOU!