Figure 5.

Right ventricular crista supraventricularis in HCM. When determining. where to measure the maximal LV wall thickness, it is important to be aware that HCM patients often have prominent and hypertrophied right ventricular muscular structures, the most common of which is the crista supraventricularis. In some HCM patients, the crista supraventricularis is not only significantly hypertrophied (panel A, outlined in red) but not uncommonly inserts from its origin in the RV cavity to directly adjacent to the ventricular septum. As a result, this RV muscle structure may be inappropriately included in the measurement of septal thickness---resulting in an overestimation of the maximal LV wall thickness; Reproduced with permission, from Maron MS et al.[47]. In order to avoid including the crista supraventricularis as part of the septum, close inspection of the CMR short-axis cine images can help clarify this issue; (B) in a different HCM patient than panel A, the crista supraventicularis muscle is noted to move away from the septum toward the RV cavity with a small area of blood pool noted between the crista and septum (arrow), allowing for a more accurate delineation of the epicardial border of the septum (asterisk).