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Management of the mitral valve in patients with obstructive hypertrophic cardiomyopathy

Joon Hwa Hong1, Anita Nguyen2, Hartzell Vernon Schaff2

  • 1Cardiovascular Surgery, Heart Research Institute, Chung-Ang University College of Medicine, Seoul, Republic of Korea.

Indian Journal of Thoracic and Cardiovascular Surgery
|October 16, 2020
PubMed

Insights

Septal myectomy effectively treats obstructive hypertrophic cardiomyopathy. Mitral valve intervention during this surgery is rarely needed unless intrinsic valve disease is present.

Area of Science:

  • Cardiovascular Surgery
  • Cardiology
  • Cardiac Anatomy

Background:

  • Obstructive hypertrophic cardiomyopathy (oHCM) is a significant cause of morbidity.
  • Septal myectomy is the established surgical treatment for symptomatic oHCM unresponsive to medical therapy.
  • Controversy exists regarding the need for concurrent mitral valve intervention during septal myectomy.

Purpose of the Study:

  • To review the role and necessity of mitral valve intervention in patients undergoing septal myectomy for oHCM.
  • To discuss anatomical considerations, imaging techniques, and surgical strategies for mitral valve management in oHCM.

Main Methods:

  • Review of surgical outcomes and clinical experience at Mayo Clinic with over 3000 septal myectomy procedures.
  • Analysis of anatomical factors influencing mitral valve function in oHCM.
  • Evaluation of imaging modalities for assessing mitral valve pathology in oHCM.

Main Results:

  • Septal myectomy reliably alleviates left ventricular outflow tract obstruction, systolic anterior motion of the mitral valve, and associated regurgitation.
  • Mitral valve operation is infrequently required in patients without intrinsic mitral valve disease (e.g., leaflet prolapse, severe calcific stenosis).
  • Mayo Clinic's extensive experience suggests a conservative approach to mitral valve intervention during myectomy is often appropriate.

Conclusions:

  • Septal myectomy is a highly effective treatment for obstructive hypertrophic cardiomyopathy.
  • Routine mitral valve intervention is not necessary in all patients undergoing septal myectomy.
  • Careful patient selection and assessment for intrinsic mitral valve disease are crucial for guiding surgical decisions.

Keywords:
Hypertrophic cardiomyopathyMitral valveMyectomy

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