Apical aneurysms are outpouchings at the apex of the left ventricle, described as discrete, thin-walled dyskinetic or akinetic segments of the most distal portion of the ventricular chamber (Figure). Apical aneurysms are relatively rare in hypertrophic cardiomyopathy (HCM) with subaortic obstruction, but have been reported in 15% to 30% of patients with apical HCM (ApHCM) or midventricular obstruction (MVO). Aneurysms are associated with a wide spectrum of adverse outcomes including sudden cardiac death, ventricular arrhythmias, heart failure, and mortality.^1,2 In a cohort of 93 patients with HCM and apical aneurysms, Rowin and colleagues¹ reported a combined adverse event rate (cardiac-related mortality, heart failure, malignant arrhythmias requiring intervention, and thromboembolic events) of 6.4% per year. Furthermore, in a recent review, Jan et al² reported overall mortality in patients with apical aneurysms of 9% to 10.5% over a mean/median follow-up of 2 to 6.5 years.

Apical aneurysms in hypertrophic cardiomyopathy. A, Apical aneurysm of the left ventricle and midventricular obstruction. B, Dashed lines depict site of aneurysm resection and myectomy. C, Enlarged ventricular cavity, and resolution of midventricular obstruction and aneurysm following surgery. D, Preoperative transthoracic …

顶端动脉瘤是左心室顶端的袋突，被描述为心室腔最远端部分的离散，薄壁运动障碍或运动障碍（图）。在伴有主动脉下阻塞的肥厚型心肌病（HCM）中，根尖动脉瘤相对较少，但据报道在15％至30％的根尖HCM（ApHCM）或心室中段梗阻（MVO）患者中。动脉瘤与各种不良后果相关，包括心脏骤停，室性心律失常，心力衰竭和死亡率。^1，2在93例HCM和顶端动脉瘤，Rowin和同事队列¹报告的不良事件总发生率（与心脏病有关的死亡率，心力衰竭，需要干预的恶性心律失常和血栓栓塞事件）每年为6.4％。此外，在最近的一篇综述中，Jan等[ ^2]报告说，在平均2到6.5年的平均/中位随访中，顶端动脉瘤患者的总死亡率为9％至10.5％。

肥厚型心肌病的根尖动脉瘤。 A，左心室的根尖动脉瘤和心室中部梗阻。B，虚线表示动脉瘤切除和肌瘤切除的部位。C，扩大的心室腔腔以及手术后脑室中部梗阻和动脉瘤的消退。D，术前经胸...