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Hypertrophic obstructive cardiomyopathy. Initial results and long-term follow-up after Morrow septal myectomy
J M ten Berg1, M J Suttorp, P J Knaepen
1Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands.
Insights
Morrow septal myectomy effectively treats hypertrophic obstructive cardiomyopathy (HOCM), significantly improving patient function and reducing outflow tract obstruction. This safe procedure offers excellent long-term clinical and echocardiographic results for HOCM patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents significant challenges in patient management.
- Septal myectomy is a surgical intervention aimed at alleviating left ventricular outflow tract obstruction.
Purpose of the Study:
- To evaluate the initial outcomes and long-term efficacy of Morrow septal myectomy in patients diagnosed with HOCM.
- To assess the safety and functional improvement following this surgical procedure.
Main Methods:
- A cohort of 38 consecutive patients with HOCM underwent Morrow septal myectomy.
- Data collected included perioperative events, postoperative complications, and long-term follow-up assessments.
- Doppler echocardiography was utilized to evaluate left ventricular outflow tract gradients and septal thickness.
Main Results:
- No perioperative deaths occurred; complications were minimal, including one pacemaker implantation and one small ventricular septal defect.
- All patients experienced significant functional improvement, with New York Heart Association class decreasing from 3.0 to 1.5 (P < .001).
- Doppler echocardiography demonstrated a marked reduction in peak left ventricular outflow tract gradient (72 to 6 mm Hg; P < .001) and subaortic septal thickness (23 to 15 mm; P < .001).
Conclusions:
- Morrow septal myectomy is a safe and highly effective surgical option for managing HOCM.
- The procedure yields excellent long-term clinical benefits and significant improvements in hemodynamic measurements.
- Sustained functional class improvement and reduction in outflow tract obstruction are key outcomes.
Background:
This study was performed to assess the initial results and long-term follow-up of Morrow septal myectomy for patients with hypertrophic obstructive cardiomyopathy (HOCM).
Methods And Results:
We studied 38 consecutive patients with HOCM (age, 13 to 74 years) who underwent a Morrow septal myectomy between 1977 and 1992. There were no perioperative deaths, and the postoperative course was uneventful for all except 2 of the patients. One patient required implantation of a pacemaker due to a complete heart block, and in 1 patient a small ventricular septal defect was caused. Follow-up (mean, 6.8 years) was 100% complete. No patient was reoperated for recurrent HOCM. All except 1 patient experienced a major functional improvement with a decrease of the mean New York Heart Association functional class from 3.0 before operation to 1.5 at follow-up (P < .001). Symptoms persisting during follow-up were angina pectoris in 3 of 22 patients (14%), dyspnea in 6 of 30 patients (20%), dizzy spells in 2 of 12 patients (17%), and syncope in 2 of 10 patients (20%). During follow-up no HOCM related death occurred. All patients were restudied by Doppler echocardiography. The peak gradient in the left ventricular outflow tract decreased from 72 +/- 30 mm Hg (range, 31 to 144 mm Hg) to 6 +/- 4 mm Hg (range, 0 to 20; P < .001). A systolic anterior movement was seen in 8 patients (21%) compared with 32 patients (97%) before the operation (P < .001). The left ventricular outflow tract diameter increased from 17 +/- 3 mm (range, 10 to 23 mm) to 22 +/- 3 mm (range, 15 to 33 mm; P < .001), and the mean subaortic septal thickness decreased from 23 +/- 5 mm (range, 15 to 35 mm) to 15 +/- 6 mm (range, 8 to 30 mm; P < .001).
Conclusions:
Morrow septal myectomy for patients with HOCM is a safe procedure with an excellent clinical and Doppler echocardiographic long-term follow-up.