{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T04:31:24Z","timestamp":1783139484390,"version":"3.54.6"},"reference-count":9,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2024,3,8]],"date-time":"2024-03-08T00:00:00Z","timestamp":1709856000000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wilma Beswick Senior Research Fellowship"},{"DOI":"10.13039\/501100001782","name":"Melbourne University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Hypertrophic cardiomyopathy (HCM) is often linked to systolic anterior motion (SAM) of the mitral valve, typically resulting in a posteriorly directed mitral regurgitation (MR) jet. An anteriorly directed MR jet suggests additional mitral valve pathology that may not be resolved by myectomy alone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 58-year-old construction worker with no significant medical history experienced a syncopal event and was admitted to the emergency department with acute pulmonary oedema. A systolic murmur was investigated with a trans-thoracic echocardiogram that revealed severe MR with an unusual anteriorly directed MR jet and a possible flail segment of the posterior leaflet. This finding was further characterized with a trans-oesophageal echocardiogram that revealed severe asymmetric septal hypertrophy with SAM of the mitral valve, severe mitral regurgitation into a dilated left atrium with pulmonary vein flow reversal not caused by HCM-associated SAM, and a markedly abnormal mitral valve with flail and prolapse. The patient underwent successful cardiac surgery, including mitral valve repair and septal myectomy. The patient\u2019s recovery was uneventful, allowing for a return to work within a month post-surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>The anteriorly directed MR jet served as a red flag, leading to the discovery of an independent mitral valve pathology that required surgical intervention beyond the expected treatment for SAM-associated HCM. This case highlights the complexity of assessing MR in patients with HCM and underscores the importance of characterizing MR jet direction in diagnosing additional mitral valve diseases.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae121","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T06:50:37Z","timestamp":1709794237000},"source":"Crossref","is-referenced-by-count":2,"title":["Hypertrophic cardiomyopathy with anteriorly directed mitral regurgitation is a red flag for concomitant pathology: a case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4727-6181","authenticated-orcid":false,"given":"Vincenzo","family":"Somma","sequence":"first","affiliation":[{"name":"Department of Cardiology, St Vincent\u2019s Hospital Melbourne , 41 Victoria Parade, Fitzroy, VIC 3065 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaishankar","family":"Raman","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, St Vincent\u2019s Hospital Melbourne , 41 Victoria Parade, Fitzroy, VIC 3065 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Fitzpatrick","sequence":"additional","affiliation":[{"name":"Department of Intensive Care, Albury-Wodonga Health , 201 Borella Road, East Albury, NSW 2640 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Prior","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Vincent\u2019s Hospital Melbourne , 41 Victoria Parade, Fitzroy, VIC 3065 , Australia"},{"name":"Department of Cardiology, Albury-Wodonga Health , Vermont St, Wodonga, VIC 3690 , Australia"},{"name":"Faculty of Medicine, Dentistry and Health Sciences, Melbourne University , Grattan St, Parkville, VIC 3000 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2122-9889","authenticated-orcid":false,"given":"Elizabeth","family":"Paratz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St Vincent\u2019s Hospital Melbourne , 41 Victoria Parade, Fitzroy, VIC 3065 , Australia"},{"name":"Faculty of Medicine, Dentistry and Health Sciences, Melbourne University , Grattan St, Parkville, VIC 3000 , Australia"},{"name":"HEART Research Lab, St Vincent\u2019s Institute of Medical Research , 9 Princes St Fitzroy, Fitzroy, VIC 3065 , Australia"},{"name":"Department of Sports Cardiology, Baker Heart and Diabetes Institute , 75 Commercial Rd, Prahran, VIC 3181 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,8]]},"reference":[{"key":"2024031815011135600_ytae121-B1","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/S0140-6736(04)16358-7","article-title":"Hypertrophic cardiomyopathy","volume":"363","author":"Elliott","year":"2004","journal-title":"Lancet"},{"key":"2024031815011135600_ytae121-B2","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.echo.2018.10.011","article-title":"Accuracy of jet direction on Doppler echocardiography in identifying the etiology of mitral regurgitation in obstructive hypertrophic cardiomyopathy","volume":"32","author":"Hang","year":"2019","journal-title":"J Am Soc Echocardiogr"},{"key":"2024031815011135600_ytae121-B3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.echo.2019.01.005","article-title":"Does the flow know? 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