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Changes in left atrial function, left ventricle remodeling, and fibrosis after septal myectomy for obstructive

Bing Tang1, Yunhu Song2, Qiulan Yang2

  • 1Department of Cardiac Surgery, Beijing Aortic Disease Center, Beijing Anzhen Hospital, Capital Medical University & Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China; Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

The Journal of Thoracic and Cardiovascular Surgery
|August 12, 2020
PubMed

Insights

Septal myectomy improved cardiac remodeling in obstructive hypertrophic cardiomyopathy patients. However, left ventricle myocardial fibrosis progressed post-surgery, indicating ongoing disease despite improved cardiac function.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Obstructive hypertrophic cardiomyopathy (HCM) is characterized by left ventricle hypertrophy.
  • Septal myectomy is a surgical intervention to relieve left ventricle outflow tract obstruction in HCM.
  • The impact of septal myectomy on cardiac remodeling and fibrosis requires further investigation.

Purpose of the Study:

  • To evaluate the effects of septal myectomy on left atrial function, left ventricle remodeling, and myocardial fibrosis in patients with obstructive HCM.
  • To analyze changes in cardiac structure and function using cardiac magnetic resonance imaging (CMR) before and after surgery.

Main Methods:

  • Retrospective collection of CMR data from 507 adult patients undergoing septal myectomy.
  • Follow-up CMR imaging for 57 patients to assess postoperative changes.
  • Analysis of left atrium and left ventricle dimensions, volumes, ejection fraction, and myocardial fibrosis (late gadolinium enhancement).

Main Results:

  • Septal myectomy reduced left ventricle hypertrophy and outflow tract gradients.
  • Postoperative CMR showed decreased left atrium volume and left ventricle mass, with improved left ventricle ejection fraction.
  • Despite surgical improvements, left ventricle myocardial fibrosis, assessed by late gadolinium enhancement, significantly increased after myectomy.

Conclusions:

  • Septal myectomy effectively alleviates left ventricle hypertrophy and reverses left atrium and left ventricle remodeling in obstructive HCM.
  • Myocardial fibrosis progression persists post-myectomy, highlighting the need for continued monitoring and therapeutic strategies in HCM patients.
Abstract

Keywords:
hypertrophic cardiomyopathylate gadolinium enhancementleft atrium volumeleft ventricle massseptal myectomy

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