Extended Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy with Anomalous Insertion of Chordae Tendineae

We present a case of hypertrophic cardiomyopathy with anomalous insertion of mitral valve chordae tendineae diagnosed with two-dimensional echocardiogram. A high gradient was found in left ventricular outflow tract (LVOT) obstruction, which was attributed to the fixed gradient caused by anomalous insertion of chordae tendineae in addition to the gradient of dynamic LVOT obstruction. The misinserted chordae tendineae were resected, and an extended septal myectomy was performed. Follow-up echocardiography showed reduction of the pressure gradient to less than 40 mm Hg in the LVOT, and the patient had no symptoms during the 1-year follow-up period.