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[Echocardiography in the Assessment of Intraventricular Flows and Pressure Gradients in Obstructive Hypertrophic
V А Sandrikov1, T Yu Kulagina1, E Yu Van1
1Scientific Institution "Petrovsky national research centre of surgery", Moscow.
Insights
Myomectomy significantly improves obstructive hypertrophic cardiomyopathy (OHCMP) by reducing intraventricular pressure gradients and enhancing myocardial function. This surgical correction leads to better blood flow dynamics and reduced cardiac workload.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Obstructive hypertrophic cardiomyopathy (OHCMP) presents challenges in assessing surgical outcomes.
- Intraventricular pressure gradients (IVPG) and left ventricular (LV) vortex flows are key hemodynamic parameters.
Purpose of the Study:
- To evaluate the effectiveness of myomectomy in OHCMP patients using IVPG and blood flow analysis.
- To establish hemodynamic markers for successful OHCMP surgical correction.
Main Methods:
- Transthoracic echocardiography and digital image processing were used in 42 OHCMP patients and 34 controls.
- Vector analysis calculated myocardial displacement rate (V), vortex flows, and LV apex-to-base pressure gradients pre- and post-myomectomy.
Main Results:
- Myomectomy resulted in a >50% decrease in LV apex-to-outflow IVPG and improved septal myocardial contraction velocity (p<0.001).
- Reduced LV cavity pressure gradients indicate effective OHCMP correction.
- Myomectomy alleviated mitral regurgitation and improved LV blood flow dynamics.
Conclusions:
- Post-myomectomy changes in myocardial contraction velocities, vortex blood flows, and LV apex-to-base IVPG are reliable indicators of OHCMP surgical correction effectiveness.
- Myomectomy effectively reduces myocardial workload and improves cardiac function in OHCMP.
Abstract:
Aim To evaluate results of myomectomy by intraventricular pressure gradients (IVPG) and blood flows in patients with obstructive hypertrophic cardiomyopathy (OHCMP).Material and methods The study included a total of 76 subjects, 42 patients with OHCMP (mean age, 39±7 years) and 34 healthy volunteers (mean age, 41±3 years). Prior to and after myomectomy, transthoracic echocardiography was performed and followed by digital image processing and calculation of IVPG and left ventricular (LV) vortex flows. Vector analysis was used to estimate the myocardial displacement rate (V), vortex flows, and LV apex-to-base pressure gradients.Results The study showed a dynamic decrease in the LV apex-to-outflow IVPG by more than 50% and recovery of myocardial contraction velocity in the septal area (р<0.001). The decrease in LV cavity pressure gradient serves as an index for evaluating the effectiveness of OHCMP correction. Myomectomy reduces the load on the myocardium and abolishes mitral valve regurgitation with improvement of LV blood flows as also evidenced by the dynamics of long axis velocity change during the cardiac cycle (dL / dt) and the myocardial contraction velocity (V).Conclusion Effectiveness of the surgical correction of OHCMP is based on the dynamics of myocardial contraction velocities, vortex blood flows, and a decrease in LV apex-to-base IVPG.
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