Myocardial fiber disarray and ventricular septal hypertrophy in asymmetrical hypertrophy of the heart

Abstract

Although two 19th century French pathologists and an early twentieth century German pathologist described cardiac pathological findings compatible with what we know today as 'asymmetrical hypertrophy of the heart', it remained for Donald Teare to bring attention to this entity in 1958. In nine cases of sudden death, Teare described a marked hypertrophy and thickening of the interventricular septum at postmortem examination. In five of these cases the hypertrophic process also involved the anterior wall of the left ventricle. By contrast, the posterior left ventricular wall appeared not to be involved. The process was truly asymmetric. Microscopic examination of the hypertrophic areas of the myocardium revealed myocardial fiber disarray (a very bizarre form of myocardial fiber hypertrophy) and significant amounts of interstitial fibrosis. Teare's report, together with that of Lord Brock, opened the flood gates to voluminous literature on this fascinating, sometimes controversial, but always stimulating, entity. Much has been written on the clinical, hemodynamic, angiographic, pathophysiologic, pharmacodynamic, therapeutic and pathologic aspects. A short survey is given.