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THE PLACE OF CARDIAC COMPUTED TOMOGRAPHY IN PREOPERATIVE PLANNING OF EXTENDED SEPTAL MYECTOMY IN PATIENTS WITH
M O Tregubova1, K B Rudenko1, V V Lazoryshynets1
1SI «Amosov National Institute of Cardiovascular Surgery of National Academy of Medical Sciences of Ukraine», 6 Amosova St., Kyiv, 03038, Ukraine.
Insights
Preoperative CT planning for hypertrophic cardiomyopathy (HCM) surgery helps surgeons plan septal resections precisely. This approach successfully prevented iatrogenic ventricular septal defects (VSDs) in all patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a common genetic heart condition.
- Extended septal myectomy (ESM) treats drug-refractory obstructive HCM.
- Preventing complications like iatrogenic ventricular septal defects (VSDs) remains crucial in HCM surgery.
Purpose of the Study:
- To demonstrate how preoperative CT planning can predict and mitigate technical challenges during ESM.
- To assess the role of CT in reducing the incidence of iatrogenic VSDs.
Main Methods:
- Cardiac CT was performed on 217 obstructive HCM patients before ESM.
- CT assessed left ventricular (LV) myocardium, hypertrophy distribution, and crypts.
- Mitral valve (MV) and subvalvular apparatus anatomy were evaluated, along with coronary artery patency using CAD-RADS.
Main Results:
- The study included 217 patients (49±15 years, 48% male) with symptomatic, drug-refractory obstructive HCM.
- Mean maximum interventricular septum (IVS) thickness was 20±5 mm; mean LV mass was 118±23 g/m².
- Systolic anterior motion (SAM) of the MV was present in 89.9%; MV/subvalvular anomalies in 28.6%; coronary atherosclerosis in 14.7%.
Conclusions:
- Preoperative CT provides detailed LV, IVS, MV, and subvalvular morphology.
- CT enables surgeons to plan septal resection location and volume more accurately.
- This planning strategy successfully avoided iatrogenic VSDs in all patients.
Background:
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. Extended septalmyectomy (ESM) is one of the priority methods of treatment of drug-refractory obstructive HCM. In recent years,hospital mortality during surgical correction of obstructive HCM in expert centers does not exceed 1-2 %. However,typical threatening complications of septal myectomy, such as iatrogenic ventricular septal defect (VSD) and rupture of the anterior or posterior walls of the left ventricle (LV), remain a topical issue in surgery of HCM.
Objective:
to show the role of preoperative CT-planning to predict and reduce possible technical problems associated with ESM, including iatrogenic VSD.
Methods And Materials:
This study includes 217 symptomatic patients with obstructive HCM, who from April 2016to October 2019 as one of the steps of preoperative planning underwent cardiac CT prior to ESM. Cardiac CT was performed to delineate the left ventricular myocardium, assess the distribution of hypertrophy and the presence ofcrypts. Special attention was also paid to the anatomy of the mitral valve (MV) and subvalvular apparatus. Coronaryartery patency was assessed by CAD-RADS, a standardized method for reporting the results of coronary CT angiography to determine tactics for further management of the patient.
Results And Discussion:
In the study group, the average age of patients was (49 ± 15) years, 48 % - men. All patientshad a symptomatic, drug-refractory obstructive form of HCM. The mean maximum wall thickness of the interventricular septum (IVS) was (20 ± 5) mm (range 16-33). The average LV mass was (118 ± 23) g/m2. 195 patients (89.9 %)had systolic anterior motion ( SAM) of the MV. MV and subvalvular apparatus anomalies were detected in 62 patients(28.6 %). A zone of scarring and regression of IVS after alcohol septal ablation (ASA) was detected in 7 patients(0.3 %) with residual LV outflow gradient. Coronary arteries atherosclerosis was detected in 32 patients (14.7 %).
Conclusions:
Preoperative CT-planning of septal myectomy allows to obtain information on morphology of the LV,IVS, MV and subvalvular apparatus, and gives the surgeon the advantage to form a more accurate plan for the location and volume of septal resection, and avoid complications when correcting obstructive HCM. No iatrogenic VSDwas detected in any of the patient in the study group.
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