Hypertrophic cardiomyopathy with midventricular and subvalvular obstruction in both heart ventricles

: Typical (subaortic) and atypical (midventricular or apical) obstructions of both ventricles in HOCM are rare events. This combination could be demonstrated in a 21-year-old female patient by heart catheterization and angiocardiography. Simultaneous registration via 2 catheters in each ventricle showed pressure gradients with two steps in both ventricles: RV apical/RV midventricular 70-100 mm Hg, RV midventricular/subvalvular 25 mm Hg; LV apical/LV midventricular 70 mm Hg, LV midventricular/LV subvalvular 30 mm Hg; no valvular pressure gradients. Morphology of the obstructions is demonstrated by angiography: severe bilateral septal hypertrophy with midventricular systolic obstruction, systolic obstruction of right ventricular infundibulum by hypertrophy of the crista supraventricularis, systolic apical separation in the right ventricle; stenosis of the left ventricular outflow tract by SAM, systolic apical separation in the left ventricle by hypertrophy of papillary muscles.