Canadian Journal of Cardiology
Images in Cardiology| Volume 33, ISSUE 2, P293.e7-293.e8, February 2017

“Aberrant” Papillary Muscle in a High-Endurance Athlete? The Importance of Advanced Cardiac Imaging

Published:August 24, 2016DOI:
      An asymptomatic 30-year-old high-endurance male athlete came to our outpatient clinic in Barquisimeto, Venezuela, for a general cardiovascular examination. He had no personal or family history of heart disease or sudden cardiac death. His physical examination was unremarkable and resting electrocardiogram showed sinus bradycardia, left ventricular hypertrophy, and nonspecific repolarization changes (Supplemental Fig. S1). This prompted a transthoracic echocardiogram that showed an “aberrant” papillary muscle with insertions at the left ventricular apex and hypokinesis of the midapical lateral wall (Fig. 1A; see Videos 1 and 2 , view videos online). A computed tomography (CT) coronary angiogram revealed normal origin and course of coronary arteries but an accessory left ventricular chamber (Fig. 1B). Cardiac magnetic resonance (MR) evaluation showed the presence of a muscular band creating what appeared to be a second ventricular chamber with reduced wall thickness and hypokinesis consistent with a left ventricular outpouching (LVO) (Fig. 1C; see Video 3 , view video online).
      Figure 1
      Figure 1(A) Apical 4-chamber and rotated apical 2-chamber transthoracic views shows a thick muscle bundle from the midventricular wall to the apex (arrow). (B) Cardiac computed tomography shows an “accessory” left ventricular cavity. Coronary arteries were normal (not shown). (C) Cardiac magnetic resonance 4-chamber equivalent shows distorted left ventricle (LV) contour and “accessory chamber” appearance. LVO, left ventricular outpouching; RV, right ventricle.
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