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Severe Mitral Annular Calcification in Two Cases of Hypertrophic Obstructive Cardiomyopathy

Lara Gharibeh1, Kenza Rahmouni2, Andrew M Crean3

  • 1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Ontario, Canada.

The Annals of Thoracic Surgery
|July 31, 2021
PubMed

Insights

Managing hypertrophic obstructive cardiomyopathy with severe mitral annular calcification is complex. Surgical correction involving septal myectomy and mitral valve repair effectively resolves left ventricular outflow tract obstruction and systolic anterior motion.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Imaging

Background:

  • Hypertrophic obstructive cardiomyopathy (HOCM) with severe mitral annular calcification presents complex management challenges.
  • Left ventricular outflow tract (LVOT) obstruction in HOCM is multifactorial, involving septal hypertrophy, mitral valve abnormalities, and systolic anterior motion (SAM).

Observation:

  • Severe mitral annular calcification complicates surgical approaches in HOCM.
  • Preoperative imaging and intraoperative provocation are crucial for identifying all contributing factors to LVOT obstruction.

Findings:

  • A comprehensive surgical strategy including septal myectomy, papillary muscle realignment, and aberrant tendinous resection via aortotomy successfully corrects LVOT obstruction and SAM.
  • Mitral valve repair is integral to managing HOCM with severe mitral annular calcification.

Implications:

  • This approach offers a viable solution for complex HOCM cases previously considered high-risk.
  • Accurate preoperative assessment and tailored intraoperative techniques are key to successful outcomes in HOCM surgery.

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