Sudden cardiac arrest in a 47-year-old female with hypertrophic obstructive cardiomyopathy and anomalous papillary muscle insertion: a case report with advanced multimodal imaging, pathophysiological insights, and evidence-based surgical management

This case illustrates how multimodality imaging is crucial for recognizing uncommon subvalvular variants of hypertrophic obstructive cardiomyopathy and for guiding optimal therapeutic decision-making. Surgical success in such patients relies on complete resection of obstructive structures. While ICD implantation was considered according to secondary prevention guidelines, the decision was deferred after successful surgical correction and interim protection with a wearable defibrillator. Conventional HCM risk models may not fully capture the risk profile of these rare phenotypes, underscoring the importance of individualized management.