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Quantitative Assessment of Three-Dimensional Aorto-Mitral Angle in Hypertrophic Cardiomyopathy
Jacobo Moreno Garijo1,2, Giovanni Gadotti2, Yannis Amador3
1Department of Anesthesia and Pain Management, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Insights
The 3D aorto-mitral angle in obstructive hypertrophic cardiomyopathy (HCM) did not correlate with pressure gradients after septal myectomy. Aortic shortening also did not significantly impact the angle post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Obstructive hypertrophic cardiomyopathy (HCM) is characterized by abnormal thickening of the heart muscle.
- Septal myectomy is a surgical procedure to relieve obstruction in HCM.
- The 3-dimensional aorto-mitral angle is a geometric parameter that may be altered in HCM.
Purpose of the Study:
- To investigate the relationship between the 3D aorto-mitral angle and pressure gradients in obstructive HCM patients.
- To assess the impact of septal myectomy, with or without aortic shortening, on this angle and pressure gradients.
Main Methods:
- Retrospective observational study of 67 obstructive HCM patients undergoing septal myectomy.
- Analysis of preoperative and postoperative transesophageal echocardiography to measure the 3D aorto-mitral angle.
- Doppler-derived pressure gradients were measured and correlated with the angle using linear regression.
Main Results:
- No significant correlation was found between changes in the 3D aorto-mitral angle and postmyectomy pressure gradients (r=0.03, P=.81).
- The aorto-mitral angle did not normalize after septal myectomy, despite pressure gradient reduction.
- Aortic shortening did not significantly influence the aorto-mitral angle post-surgery (97.0° ± 8.4° vs 100.4° ± 8.7°, P=.78).
Conclusions:
- The 3D aorto-mitral angle in obstructive HCM does not appear to be a significant predictor of pressure gradients after septal myectomy.
- Septal myectomy alone or with aortic shortening does not restore the aorto-mitral angle to normal values.
- Further research may be needed to understand the implications of the persistent altered aorto-mitral angle in HCM.
Background:
This study explored the correlation between the 3-dimensional aorto-mitral angle and pressure gradients in patients with obstructive hypertrophic cardiomyopathy (HCM) undergoing septal myectomy, with or without aortic shortening.
Methods:
A single-site, retrospective observational study was conducted at a tertiary-level hospital; 67 patients underwent septal myectomy for obstructive HCM. Preoperative and postoperative transesophageal images were analyzed offline to measure the end-systolic 3-dimensional aorto-mitral angle with Mitral Valve Quantification software and Doppler-derived pressure gradients. The angle's impact on pressure gradients after myectomy, with or without aortic shortening, was evaluated by linear regression.
Results:
Regression analysis found no significant relationship between aorto-mitral angle changes and postmyectomy pressure gradients (r = 0.03; 95% CI, -0.22 to 0.28; P = .81), regardless of aortic shortening. No major angle differences were observed between myectomy-only patients and those with additional aortic shortening (97.0° ± 8.4° vs 100.4° ± 8.7°; P = .78).
Conclusions:
The reduced angle seen in patients with obstructive HCM did not return to normal values after septal myectomy, even with normalized pressure gradients. Aortic shortening did not significantly influence the aorto-mitral angle after myectomy either.
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