Effect of left ventricular septal myectomy on concurrent mitral regurgitation

To assess the impact of left ventricular septal myectomy (Morrow procedure) performed for obstructive hypertrophic subaortic stenosis on co-existing mitral regurgitation, we examined the preoperative and postoperative left ventriculograms of 35 patients (13 of them women) who underwent left ventricular septal myectomy alone or with concomitant operation. The mean age was 45 +/- 3 years (range, 19 to 74 years). Patients underwent left ventriculography at an average of 15 +/- 3 months postoperatively (range, 1 to 78 months). Severity of mitral regurgitation was evaluated by two teams of reviewers. Mitral regurgitation due to catheter entrapment or to premature ventricular contraction or other arrhythmia was excluded. Overall, 51% of patients showed improvement in the severity of mitral regurgitation, and all those with more severe mitral regurgitation (ie, 3+) demonstrated improvement. The population was subdivided for analysis into those with coronary artery disease requiring bypass grafting at the time of left ventricular septal myectomy (n = 7, 20%) and those without coronary artery bypass grafting. Among the 7 patients undergoing bypass grafting, 71% demonstrated improvement in the degree of mitral regurgitation as compared with only 46% of those without bypass grafting (p less than 0.005 by X2 analysis). Significant reductions in peak gradients at rest and in response to provocation, and in New York Heart Association functional class, also occurred in both groups.