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Regression of hypertrophic cardiomyopathy after modified Konno procedure
J A Quinones1, S Y DeLeon, D A Vitullo
1Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Insights
The modified Konno procedure effectively relieved obstruction in hypertrophic obstructive cardiomyopathy, reducing symptoms and decreasing heart wall thickness. This surgical approach shows promise for managing this condition and preventing sudden cardiac death.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Medical Devices
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is associated with sudden death.
- Medical therapies like beta-blockers and calcium-channel blockers often fail to induce disease regression in HOCM.
Background:
Septal myotomy-myectomy has been known to decrease the incidence of sudden death and produce regression in hypertrophic obstructive cardiomyopathy. Use of beta-blockers or calcium-channel blockers generally does not cause regression of the disease.
Methods:
Having successfully performed modified Konno procedures in 13 patients with effective relief of diffuse subaortic stenosis, we applied the procedure in 2 patients with hypertrophic obstructive cardiomyopathy. Both patients (18 and 12 years old, respectively) presented with syncope, angina at rest, and dyspnea despite being on calcium channel blocker therapy. The echocardiographic outflow gradients were 66 mm Hg and 88 mm Hg, respectively, with moderate mitral regurgitation.
Results:
Both patients had uneventful postoperative course. At 2 years and 1.5 years postoperatively, both patients were free of angina and syncopal episodes. Echocardiography showed absence of outflow gradients and mitral regurgitation. In 1 patient the septal and posterior wall thickness decreased from 3.4 and 1.7 cm preoperatively to 2.6 and 0.9 cm, respectively, postoperatively. In the other patient, the thickness decreased from 2.4 and 0.9 cm preoperatively to 0.8 and 0.7 cm, respectively, postoperatively. Left atrial diameter decreased from 5.4 to 4.7 cm in 1 patient, 3.5 to 2.6 cm in the other.
Conclusions:
We believe that the modified Konno procedure could produce more effective relief of obstruction and, therefore, significant regression and further reduction in sudden death in hypertrophic obstructive cardiomyopathy. On the basis of our experience, albeit limited, we encourage its application.