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Hypertrophic obstructive cardiomyopathy: the mitral valve could be the key

Filip Dulguerov1, Cecilia Marcacci1, Clara Alexandrescu1

  • 1Cardiothoracic Center of Monaco, Monaco Cedex, Monaco.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|January 22, 2016
PubMed

Insights

Surgical correction of mitral valve abnormalities in hypertrophic obstructive cardiomyopathy (HOCM) significantly improves patient outcomes. Addressing mitral valve pathology alongside septal resection leads to excellent mid-term results and symptom relief.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology
  • Cardiac Surgery

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) is often associated with mitral valve abnormalities.
  • Mitral valve pathology, including leaflet size and geometry, plays a crucial role in HOCM.
  • Surgical correction of obstruction in HOCM typically involves septal resection.

Purpose of the Study:

  • To evaluate the mid-term outcomes of systematically correcting mitral valve abnormalities in patients with HOCM.
  • To assess the efficacy of a two-stage surgical procedure addressing both septal obstruction and mitral valve pathology.
  • To determine if mitral valve intervention is a key component in HOCM treatment.

Main Methods:

  • 16 symptomatic HOCM patients (NYHA class 3-4) underwent a two-stage surgical procedure.
  • Stage 1: Septal resection via aortic valve and detached anterior mitral leaflet.
  • Stage 2: Mitral valve repair (leaflet resection/neochordae, pericardial patch augmentation).

Main Results:

  • No in-hospital or late mortality observed.
  • All patients improved to NYHA Class 1 at follow-up.
  • Significant reduction in mitral regurgitation (MR) and intraventricular gradient (mean 15 mmHg).

Conclusions:

  • Mitral valve pathology is a critical component of HOCM that requires surgical attention.
  • A two-stage procedure addressing both septal and mitral valve issues yields good mid-term results.
  • Further investigation into isolated mitral valve treatment for HOCM may be warranted.
Abstract

Keywords:
Aortic approachExtensive myectomyHypertrophic obstructive cardiomyopathyMitral approachMitral valve repairSystolic anterior motion

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