A Case of Pseudo-Hypertrophic Cardiomyopathy: A Congenital Heart Disease

A 65-year-old woman with a history of diabetes and a prior diagnosis of hypertrophic cardiomyopathy was admitted to the Department of Cardiology for palpitations. Cardiac examination revealed a 3/6 holosystolic murmur over the left parasternal area. Echocardiography showed that the aorta extended from the morphological systemic ventricle (RV), which was identified by the three-leaflet tricuspid valve (Fig. 1) that was inserted more apically than the mitral valve (Fig. 2). The pulmonary trunk, identified by its bifurcation, arose from the morphological “pulmonic” ventricle (LV) (Fig. 3). The RV was mildly dilated, the septum wall was 18 mm thick, and systolic RV function was mildly reduced (ejection fraction 40%). There was moderate atrioventricular (tricuspid) valve regurgitation. The LV showed normal function and there was mild atrioventricular (mitral) valve regurgitation. There was mild aortic regurgitation but no pulmonary valvular stenosis. A persistent patency of ovalshaped foramen was found. The aorta was anterior and to the left of the pulmonary trunk, and the two vessels were side by side. Holter monitoring demonstrated incessant tachycardia with only brief periods of sinus rhythm. The patient was submitted to electrophysiological evaluation, and the accessory pathway was successfully ablated using radiofrequency pulses.