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Septal Myectomy in patients with previous coronary revascularization - hypertrophic cardiomyopathy masquerading as

Jessey Mathew1, Anita Nguyen1, Rick A Nishimura2

  • 1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.

International Journal of Cardiology
|June 23, 2020
PubMed

Insights

Many patients with hypertrophic cardiomyopathy (HCM) symptoms persist after coronary revascularization, necessitating septal myectomy. Early myectomy is crucial for those with ongoing shortness of breath post-intervention.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery

Background:

  • Obstructive hypertrophic cardiomyopathy (HCM) can mimic ischemic heart disease, leading to unnecessary coronary revascularization.
  • Some patients do not experience symptomatic improvement after procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Purpose of the Study:

  • To assess the clinical presentations and outcomes of patients with obstructive HCM who underwent septal myectomy after prior coronary revascularization.
  • To evaluate the timing and necessity of septal myectomy in patients with persistent symptoms post-PCI/CABG.

Main Methods:

  • Retrospective analysis of 166 adult patients with obstructive HCM undergoing septal myectomy between 08/1996 and 07/2017.
  • Assessment of functional status before and after coronary intervention, and outcomes following myectomy, including analysis of symptom persistence.

Main Results:

  • Nearly 25% of patients required septal myectomy within one year of coronary revascularization due to persistent symptoms.
  • Patients with persistent shortness of breath post-PCI/CABG underwent myectomy earlier than those whose symptoms initially improved.
  • Single vessel disease was common in patients undergoing PCI (73%) but rare in those undergoing CABG (9%).

Conclusions:

  • A significant proportion of obstructive HCM patients undergo coronary revascularization for symptoms that may not be ischemia-related.
  • These findings underscore the importance of evaluating for dynamic obstruction in HCM, especially when symptoms persist after revascularization.
  • Septal myectomy is an effective treatment for obstructive HCM, even in patients with a history of coronary revascularization.
Abstract

Keywords:
Coronary artery bypass graftingCoronary artery diseaseHypertrophic cardiomyopathyPercutaneous coronary interventionSeptal Myectomy

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