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Surgical Resolution of Patients With Hypertrophy of Papillary Muscles in Hypertrophic Cardiomyopathy

Rutilio Daniel Jiménez Espinosa1, Jesús Saucedo Castillo1, Luis León Hernández Trejo1

  • 1Department of Cardiothoracic Surgery, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, MEX.

Cureus
|September 16, 2024
PubMed

Insights

Surgical treatment successfully reduced outflow tract gradients in two patients with generalized hypertrophic cardiomyopathy affecting papillary muscles. This intervention improved cardiac function in complex cases, including one with prior unsuccessful ablation.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Hypertrophic Cardiomyopathy

Background:

  • Hypertrophic cardiomyopathy (HCM) is a spectrum of myocardial diseases.
  • It can involve various cardiac structures, including the interventricular septum, left ventricular outflow tract (LVOT), papillary muscles, and mitral valve.
  • Papillary muscle hypertrophy can significantly contribute to LVOT obstruction in HCM.

Observation:

  • This article details the surgical treatment of two patients with generalized HCM.
  • Both patients presented with significant papillary muscle hypertrophy and LVOT gradients exceeding 55 mmHg.
  • One patient had a history of unsuccessful chemical ablation and coronary disease; the other developed HCM during pregnancy.

Findings:

  • Successful surgical intervention significantly reduced LVOT gradients in both patients.
  • Post-operative gradients were less than 10 mmHg, indicating effective relief of obstruction.
  • Surgical treatment provided a viable option for complex HCM cases unresponsive to other therapies.

Implications:

  • Surgical management can be effective for HCM with predominant papillary muscle hypertrophy and LVOT obstruction.
  • This approach offers a solution for patients with complex comorbidities or previous treatment failures.
  • Further research into surgical techniques for specific HCM phenotypes is warranted.

Keywords:
hypertrophic cardiomyopathymorrow procedurepapillary muscle hypertrophyseptal hypertrophyseptal myectomy

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