Figure 4

CMR end-diastolic images demonstrating diversity of the phenotypic expression within HCM. (A) increased wall thickness in the superior segment (thin arrow) and extreme hypertrophy of the inferior segment (thick arrow) of the RV wall; Reproduced with permission, from Maron MS et al.[29](B) medium-sized LV apical aneurysm (arrowheads) and maximal LV wall thickening at mid-ventricular level with muscular apposition of septum and LV free wall producing distinct proximal (P) and distal chambers; Reproduced with permission, from Maron MS et al.[50](C) anomalous insertion of papillary muscle (thin arrows) directly into the anterior leaflet of the mitral valve (thick arrow) (in the absence of chordae tendinae) producing obstruction to blood flow from the apposition of the papillary muscle and basal ventricular septum (asterisk); (D) extraordinarily long anterior mitral valve leaflet measuring 33 mm; PML is of normal length (although not well visualized in this frame); Reproduced with permission, from Maron MS et al.[53](E) multiple accessory papillary muscles, 4 in number (arrows); Reproduced with permission from Harrigan C et al.[54](F) 7-year-old asymptomatic genotype positive/phenotype negative HCM girl with 3 deep myocardial crypts in the basal (posterior) inferior LV free wall. Ao = aorta; RV = right ventricle; LA = left atrium; LV = left ventricle; VS = ventricular septum