LV Non-Compaction

Female, 61 y.
Non-compacted myocardium is seen in the LV apex (upper 4 slices). LV systolic function is normal. Left column: 3 apical orthogonal views. The 9 short axis views on the right cut through the LV cavity from mid-cavity (yellow horizontal dotted line on the apical views) to the apex (white dotted line) starting from the lower right slice up to the upper left slice. Typical muscular indentations are seen near the apex (lateral to inferior wall), whereas the apex is obliterated by the non-compacted myocardium.

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Wall motion analysis: apical inferior septum

Comparison of normal vs. typical cases of abnormal wall motion of the apical septum:

1. (upper left) Normal

2. (upper right) Akynesia

3. (lower left) Aneurysm (abnormal diastolic left ventricular geometry with systolic expansion)

4. (lower right) Extensive dyskinesis secondary to pacemaker activation (electrode in right ventricular apex)

LV outflow tract diameter measurement

Figure 1. When the left ventricular outflow tract (lvot) diameter is difficult to visualize in the parasternal long axis view, adding color Doppler may help in delineating the septal endocardium just proximal to the aortic valve annulus (Figure 1, green arrow), where lvot diameter has to be measured. In Figure 1, blue systolic velocities in the lvot help the positioning of the caliper (Figure 2) (blue cross) on the septal endocardium.

Figure 2

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