A 67 years-old male with subacute inferior myocardial infarction was referred to our hospital for coronary angiograhy which revealed critical proximal stenosis and distal chronic total occlusion of the right coronary artery (stent implantation performed for proximal lesion and medical follow up for distal occlusion planned). At predischarge echocardiogram, a myocardial defect was observed at mid-inferior segment and later multislice computed tomography (MSCT) for morphological and coronary evaluation is performed. Echocardiogram and MSCT images are demonstrated in Figure 1.
Hypertrophic cardiomyopathy (HCM) is characterized by diverse patterns of left ventricular (LV) hypertrophy. Presence of congenital clefts or diverticulum of LV is a rare cardiac malformation described in HCM. Recently, unusual deep crypts of the LV basal septum have been reported in HCM patients, with unknown clinical significance. Co-existance of basal septal crypt, mid-inferior defect and obstructive hypertrohic cardiomyopathy is demonstrated in the present patient. If inferior large myocardial defect (localized at the middle of hypoperfused segment) is a necrotic lesion or combination of a congenital defect and necrosis togethter is to be discussed.
