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[MSB-73] Hypertrophic Obstructive Cardiomyopathy Management in the Pediatric Population: The Dilemma of Mitral Valve

Nazlı Melis Coşkun Yücel1, Ahmet Aydın1, Timuçin Sabuncu1

  • 1Department of Cardiovascular Surgery, Hacettepe University Faculty of Medicine, Ankara, Türkiye.

Turk Gogus Kalp Damar Cerrahisi Dergisi
|May 5, 2025
PubMed

Insights

Mitral valve replacement combined with myectomy is more effective for pediatric hypertrophic cardiomyopathy (HOCM) patients, improving left ventricular cavity and reducing obstruction. This combined approach safely manages HOCM in children.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Hypertrophic cardiomyopathy (HOCM) in pediatric patients presents unique surgical challenges.
  • Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) are common complications.
  • Surgical intervention is necessary for symptomatic HOCM in children.

Purpose of the Study:

  • To evaluate the surgical experience with pediatric HOCM patients.
  • To compare outcomes of isolated myectomy versus combined myectomy and mitral valve replacement (MVR).
  • To assess the safety and efficacy of MVR in conjunction with myectomy for pediatric HOCM.

Main Methods:

  • Retrospective review of 10 pediatric HOCM patients undergoing surgery.
  • Procedures included isolated myectomy or myectomy with MVR.
  • Surgical approach involved aortotomy, left atriotomy, and apical ventriculotomy.

Main Results:

  • Eight patients underwent myectomy with MVR; two had isolated myectomy.
  • Isolated myectomy resulted in persistent SAM and higher LVOT gradients.
  • MVR in pediatric patients with narrow annuli was well-tolerated using low-profile valves.

Conclusions:

  • Combined MVR and myectomy is more effective in pediatric HOCM for LVOT gradient reduction and cavity enlargement.
  • This approach prevents SAM and offers greater cavity volume gain.
  • MVR combined with myectomy is a safe and effective surgical option for pediatric HOCM.
Abstract

Keywords:
Hypertrophic obstructive cardiomyopathymitral valve replacement.

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