Myocardial crypts (or myocardial clefts or fissures) refer to discrete clefts or fissures in otherwise compacted myocardium of the left ventricle. They are thought to represent a distinctive morphological expression of hypertrophic cardiomyopathy, occurring with different frequency in these patients with or without left ventricular hypertrophy.
They are usually defined as invaginations penetrating >50% of the thickness of adjoining compact myocardium usually perpendicular to the long axis of the left ventricle, tending to narrow or occlude in systole and without local hypokinesia or dyskinesia 5.
While they can be present in the normal population but increasingly common in those with hypertrophic cardiomyopathy and hypertensive cardiomyopathy 3.
Possible imaging differential considerations include:
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- 2. Maron MS, Rowin EJ, Lin D, Appelbaum E, Chan RH, Gibson CM, Lesser JR, Lindberg J, Haas TS, Udelson JE, Manning WJ, Maron BJ. Prevalence and clinical profile of myocardial crypts in hypertrophic cardiomyopathy. Circulation. Cardiovascular imaging. 5 (4): 441-7. doi:10.1161/CIRCIMAGING.112.972760 - Pubmed
- 3. Child N, Muhr T, Sammut E, Dabir D, Ucar EA, Bueser T, Gill J, Carr-White G, Nagel E, Puntmann VO. Prevalence of myocardial crypts in a large retrospective cohort study by cardiovascular magnetic resonance. Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. 16: 66. doi:10.1186/s12968-014-0066-0 - Pubmed
- 4. Hoey ET, Teoh JK, Pakala V, Ganeshan A. Depiction of myocardial crypts in hypertrophic cardiomyopathy by cardiovascular MRI. Postgraduate medical journal. 89 (1056): 610-1. doi:10.1136/postgradmedj-2013-132072 - Pubmed
- 5. Deva DP, Williams LK, Care M, Siminovitch KA, Moshonov H, Wintersperger BJ, Rakowski H, Crean AM. Deep basal inferoseptal crypts occur more commonly in patients with hypertrophic cardiomyopathy due to disease-causing myofilament mutations. Radiology. 269 (1): 68-76. doi:10.1148/radiol.13122344 - Pubmed
- 6. Lorenzo N, Rodriguez AM, Bartolomé S, González R. Myocardial Cleft in a Patient with Acute Coronary Syndrome Assessed by Multimodal Imaging. Heart views : the official journal of the Gulf Heart Association. 18 (1): 18-20. doi:10.4103/1995-705X.206204 - Pubmed
- 7. Wein M, Wolf-Puetz A, Niehues R, Klein T, Kilner PJ, Klein RM. Multiple left ventricular inferoseptal clefts. Multimodality imaging appearance and differential diagnosis. Herz. 36 (5): 438-43. doi:10.1007/s00059-011-3424-9 - Pubmed
- 8. Johansson B, Maceira AM, Babu-Narayan SV, Moon JC, Pennell DJ, Kilner PJ. Clefts can be seen in the basal inferior wall of the left ventricle and the interventricular septum in healthy volunteers as well as patients by cardiovascular magnetic resonance. Journal of the American College of Cardiology. 50 (13): 1294-5. doi:10.1016/j.jacc.2007.06.026 - Pubmed