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Complete Heart Block After Aortic Valve Repair and Septal Myectomy in a Patient With Rheumatic Heart Disease
Marvi Moreno1, Wilbur Ji2, Brianna Yee1
1Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas (UNLV), Las Vegas, USA.
Insights
Hypertrophic obstructive cardiomyopathy (HOCM) surgery is safe, but complete heart block (CHB) risk factors are unclear. Rheumatic heart disease may predispose HOCM patients to CHB after septal myectomy and valve repair.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Surgical myectomy with concomitant valvular repair is a safe treatment for hypertrophic obstructive cardiomyopathy (HOCM).
- Risk factors predisposing patients to complete heart block (CHB) following these procedures remain incompletely understood.
Observation:
- A 66-year-old female with rheumatic heart disease and HOCM presented for aortic valve (AV) repair and septal myectomy.
- The patient developed complete heart block (CHB) post-operatively.
- Histology revealed septal fibrosis, suggesting atrioventricular conduction disease secondary to rheumatic fever.
Findings:
- Rheumatic heart disease and associated septal fibrosis may be a risk factor for developing complete heart block (CHB) after septal myectomy in HOCM patients.
- The patient's presentation suggests a link between underlying rheumatic etiology and post-surgical conduction abnormalities.
Implications:
- Understanding the specific etiology of HOCM is crucial for identifying patients at higher risk for CHB.
- Preoperative elucidation of HOCM etiology can guide surgical planning and postsurgical management strategies.
- This case underscores the importance of considering underlying conditions like rheumatic heart disease in patients undergoing HOCM surgery to optimize clinical outcomes.
Abstract:
Surgical myectomy with concomitant valvular repair has been demonstrated to be safe in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). It is unclear which risk factors predispose patients to develop complete heart block (CHB). We present a unique case of a 66-year-old female with rheumatic heart disease and HOCM admitted for aortic valve (AV) repair and septal myectomy, complicated by a presentation of complete heart block. The histology slide showed fibrosis of the septum, suggesting atrioventricular conduction disease from rheumatic fever, which likely contributed to her presentation. This case highlights the importance of elucidating the etiology of HOCM before undergoing cardiac surgery to guide postsurgical management and improve clinical outcomes.
