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Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or

Kenji Minakata1, Joseph A Dearani, Rick A Nishimura

  • 1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn, USA.

The Journal of Thoracic and Cardiovascular Surgery
|February 6, 2004
PubMed

Insights

Surgical relief of mitral valve anomalies and extended septal myectomy effectively treat hypertrophic obstructive cardiomyopathy. This approach avoids mitral valve replacement, significantly reduces obstruction and regurgitation, and yields excellent long-term outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology
  • Cardiac Surgery

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) often requires surgical intervention.
  • Transaortic septal myectomy is a primary treatment, but mitral subvalvular apparatus anomalies can complicate outcomes.
  • Mitral valve replacement is sometimes considered for complex cases.

Purpose of the Study:

  • To evaluate the efficacy of preserving the mitral valve in HOCM patients with anomalous mitral subvalvular apparatus.
  • To assess surgical techniques aimed at relieving obstruction while maintaining the native mitral valve.

Main Methods:

  • A retrospective review of 56 patients (ages 2-77) with HOCM and anomalous mitral subvalvular apparatus (chordae or papillary muscles) undergoing surgery between 1975 and 2002.
  • Procedures included resection of anomalous chordae, relief of papillary muscle fusion, and extended septal myectomy.
  • 82% of patients were initially in New York Heart Association (NYHA) class III or IV.

Main Results:

  • No early mortality or need for mitral valve replacement.
  • Significant reduction in mean peak left ventricular outflow tract pressure gradients (70 to 4.9 mm Hg) and mitral regurgitation (grade 2.3 to 1.0; P <.001).
  • At a mean follow-up of 2.8 years, 95% freedom from reoperation and 98% of patients in NYHA class I or II.

Conclusions:

  • HOCM with mitral subvalvular anomalies can be successfully managed without mitral valve replacement.
  • Surgical correction of anomalies combined with extended septal myectomy offers excellent early and late results.
  • This strategy significantly alleviates obstruction and mitral regurgitation, improving patient functional status.
Abstract

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