Surgical management of hypertrophic obstructive cardiomyopathy
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ORIGINAL ARTICLE
Surgical management of hypertrophic obstructive cardiomyopathy Arzu Antal1 · Kamil Boyacıoğlu2 · Mustafa Akbulut1 · Hızır Mete Alp3 Received: 4 October 2019 / Accepted: 29 January 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Objective Septal myectomy is the most effective treatment modality for hypertrophic obstructive cardiomyopathy. A retrospective study was conducted to evaluate outcomes of surgical myectomy alone or with concomitant mitral valve procedures. Methods From December 2011 through December 2016, a total of 41 patients with symptomatic hypertrophic obstructive cardiomyopathy were operated. There were 14 females and 27 males, aged between 18 and 73 years (mean 49.8 years). All patients had drug refractory symptoms (dyspnea, palpitation, chest pain, fainting, limitation of daily physical activities). Twenty-one patients received septal myectomy alone, 10 patients had SM with mitral valve repair and 10 patients had SM with mitral valve replacement. The average follow-up was 38.45 ± 12.18 months. Results Surgery led to symptomatic improvement in all patients. None of the patients were left with NYHA Class III and IV symptoms after surgery. The improvement in left ventricular outflow tract gradient was from 116.65 mmHg preoperatively to 22.47 mmHg. Mean septal thickness decreased from 2.35 to 1.74 cm. Post procedure permanent pacemaker implantation was required for one patient due to complete heart block, and 2 intracardiac devices were implanted due to resistant arrthymia. None of the patients required a repeat procedure during follow-up period. Operative mortality was 2.4%. Conclusion Septal myectomy is safe and effective. Concomitant mitral operations do not increase morbidity and mortality. Keywords Septal myectomy · Hypertrophic obstructive cardiomyopathy
Introductıon Hypertrophic cardiomyopathy (HCM) is a genetic disorder of heart muscle, characterized by hypertrophy of the myocardium and small left ventricular cavity [1]. The disease has a diverse pathophysiology and clinical course. Obstruction of left ventricular outflow tract (LVOT) is the major hallmark of the disease [1, 2]. This obstruction is partly due to hypertrophy of basal septum and partly to systolic anterior motion (SAM) of mitral leaflets towards septum during systole, causing secondary mitral regurgitation. Intrinsic mitral valve pathologies of either the leaflets or subvalvular * Arzu Antal [email protected] 1
Clinic of Cardiovascular Surgery, University of Health Sciences, Kartal Kosuyolu Heart Research Center, Istanbul, Turkey
2
Clinic of Cardiovascular Surgery, Bagcılar Research and Training Hospital, Istanbul, Turkey
3
Clinic of Cardiovascular Surgery, Okan University Hospital, Istanbul, Turkey
apparatus may also contribute to left ventricular outflow obstruction (LVOTO) [3]. The aim of the treatment in symptomatic patients is to relieve the obstruction by medical therapy and prevent sudden changes in preload and afterload of left ventricle to avoid dynamic obstru
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