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Hypertrophic cardiomyopathy complicated by atrial septal defect and pulmonary hypertension

In addition to the potential for outflow tract obstruction, hypertrophic cardiomyopathy is characteristically associated with marked noncompliance of the left ventricle leading to the development of left atrial hypertension and atrial distention. With progressive left atrial distention, a patent foramen ovale may stretch and permit a significant left-to-right shunt. In such cases, both chronic left atrial hypertension and pulmonary overcirculation from the resultant atrial septal defect (ASD) may contribute to the development of significant pulmonary hypertension. Understanding the hemodynamics of hypertrophic cardiomyopathy, ASD, and pulmonary hypertension is of great importance particularly as it relates to the issue of percutaneous closure of the ASD in this setting. This issue of Hemodynamic Rounds describes such a case to illustrate the salient points.