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[Surgical treatment of pediatric hypertrophic obstructive cardiomyopathy using an original approach]
Insights
This study introduces a novel surgical technique for pediatric hypertrophic obstructive cardiomyopathy (HOCM). The procedure effectively reduces intraventricular gradients and septal thickness in children, offering a promising treatment option.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Hypertrophic Cardiomyopathy
Background:
- Pediatric hypertrophic obstructive cardiomyopathy (HOCM) presents significant challenges, often failing to respond to medical therapy.
- Existing surgical interventions may involve risks of entering the left ventricular cavity.
Purpose of the Study:
- To present an original surgical technique for correcting pediatric HOCM.
- To evaluate the efficacy and safety of this technique in eliminating ventricular outflow tract obstruction.
Main Methods:
- Surgical correction involving excision of hypertrophied myocardium without entering the left ventricular cavity.
- Application of the technique in 15 pediatric patients (aged 5-15) with HOCM unresponsive to medical treatment.
- Follow-up assessment using echocardiography (EchoCG) to measure intraventricular gradients and septal thickness.
Main Results:
- Significant reduction in left ventricular (LV) and right ventricular outflow tract (RVOT) gradients post-surgery.
- Mean LV gradient decreased from 72.9 to 12.7 mmHg; mean RVOT gradient reduced from 43.6 to 4.3 mmHg.
- Septal thickness decreased from 31.5 to 16.5 mm, with all patients maintaining sinus rhythm post-operatively.
Conclusions:
- The described surgical technique offers an effective method for treating pediatric HOCM, particularly in cases resistant to medical management.
- This approach provides a viable alternative, potentially becoming the method of choice for specific pediatric HOCM cases.
- The technique successfully addresses obstruction without necessitating entry into the left ventricular cavity, enhancing safety.
Abstract:
The authors offer an original technique of surgical correction of pediatric hypertrophic obstructive cardiomyopathy (HOCM), which allows excision of the hypertrophied area and elimination of the obstruction from the cone part of the right ventricle (RV) without penetrating into the LV cavity. 15 children aged 5 to 15 years have been operated on in Bakulev Scientific Center for Cardiovascular Surgery using this technique. 8 of the patients had simultaneous obstruction of the left and right ventricular outflow tract (LVOT and RVOT), 1 patient had RV obstruction. Medical therapy had failed in all cases. The follow-up period was 28 +/- 7 months. EchoCG examination, performed after the surgical treatment, found a decrease of the intraventricular gradient in LV from 72.9 +/- 8.9 to 12.7 +/- 5.5 mmHg; the mean gradient in RVOT also reduced from 43.6 +/- 5.7 to 4.3 +/- 2.7 mmHg. According to the EchoCG, septal thickness reduced from 31.5 +/- 6.5 to 16.5 +/- 4.1 mm. Sinus rhythm was noted in all the patients after the surgery and during the follow-up. The method proposed by the authors is preferable in surgical treatment of children with various forms of hypertrophic cardiomyopathy unresponsive to medical treatment and is a method of choice in a significant number of cases.
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