Author + information
Hypertrophic cardiomyopathy (HCM) is a spectrum with not only asymmetrical hypertrophy but also with multiple anatomic abnormalities that can contribute to obstruction. The beneficial results of septal myectomy in relieving LV outflow tract (LVOT) obstruction are well known. We examined the need for additional surgical procedures, beyond septal myectomy, for optimally treating obstructive HCM.
We studied 132 consecutive patients (ages 19-79 years) undergoing septal myectomy. The decision for additional repair beyond myectomy was based on the echocardiographic/magnetic resonance (CMR) findings and direct visual inspection of the anatomy during surgery. All patients had a significant LVOT gradient (≥ 30mmHg). Preoperative mean mitral regurgitation (MR) grade was 2.2 ± 0.9.
Of the 132 patients who underwent myectomy, valvular and subvalvular abnormalities were noted in 73% on the preoperative echocardiogram and/or CMR. They included elongated mitral valve (MV) leaflets, papillary muscle (PM) pathology including abnormal attachments, and abnormal muscle bands. Intraoperative anatomic examination confirmed these findings and revealed additional abnormalities such as small anomalous muscle bands/chordae tendinae. In addition to extended septal myectomy, the following procedures were performed: plication of elongated MV leaflets in 15, resculpturing of hypertrophied/anomalous PM in 33, resection of hypertrophied muscle bundles in 23, resection of abnormal inter-PM trabeculae in 16, and removal of abnormal chordal attachments in 132. The MV was repaired in 24 patients (plicated in 15, band placed in 9). Postoperatively, LVOT obstruction was relieved in 96% of the patients, with a small residual gradient seen in 5 patients. Mean MR grade decreased to 1.4 ± 0.8.
Besides septal hypertrophy, HCM patients show a spectrum of intracardiac abnormaities. While undergoing surgery, a sizeable proportion of patients require repair of the MV and/or the subvalvular structures as well. A comprehensive approach of septal myectomy and repair of the MV and subvalvular structures constitute the current surgical strategy for symptomatic HCM.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Hypertrophic Cardiomyopathy: Variants and Outcomes
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1122-148
- 2013 American College of Cardiology Foundation