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[Evaluation of surgical procedures based on the types of hypertrophied obstructive cardiomyopathy]
K Nakano1, K Kawazoe, S Nagata
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Insights
Surgical interventions for hypertrophic obstructive cardiomyopathy (HOCM) show promise. While effective for asymmetric septal hypertrophy and mid-ventricular obstructive hypertrophy, diffuse hypertrophy may require further surgical consideration.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents diverse morphologies.
- Surgical management aims to alleviate pressure gradients and improve symptoms.
Purpose of the Study:
- To review surgical outcomes for different types of HOCM.
- To evaluate the efficacy of septal myotomy/myectomy and mitral valve replacement (MVR).
Main Methods:
- Retrospective review of 20 HOCM patients.
- Classification into Asymmetric Septal Hypertrophy (ASH), Diffuse Hypertrophy (DIF), and Mid-Ventricular Hypertrophy (MID).
- Analysis of surgical procedures: myotomy (My), myectomy (Mye), and MVR.
Main Results:
- ASH patients (n=11) treated with My/Mye (n=9) or MVR (n=2) showed good outcomes.
- DIF patients (n=6) treated with My/Mye (n=4) or MVR (n=2) had persistent gradients in some cases.
- MID patients (n=3) treated with MVR showed positive results.
- All patients with preoperative severe mitral regurgitation (n=4) were successfully treated.
- Postoperative NYHA functional class improved to II or less in all patients.
Conclusions:
- Myotomy/myectomy is effective for ASH.
- Mitral valve replacement is recommended for MID.
- Further evaluation of surgical strategies for DIF is warranted.
Abstract:
The surgical procedures were reviewed based on the types of hypertrophied obstructive cardiomyopathy in 20 patients. The patients were classified in three groups: (1) Asymmetric septal hypertrophy (ASH), (2) Atypical or diffuse concentric hypertrophy (DIF), (3) Mid ventricular obstructive hypertrophy (MID). Among 11 patients with ASH, the ventricular septal myotomy (My) or the myotomy-myectomy (Mye) were performed in 9 patients and MVR was performed in 2 patients. Among 6 patients with DIF, My or Mye were performed in 4 and MVR was performed in 2. All three patients with MID were treated with MVR. The intraventricular systolic pressure gradient greater than 40 mmHg was still existent postoperatively in one ASH patient on whom Mye was performed and in 3 DIF patients on whom My or Mye were performed. The four patients had III degree mitral regurgitation preoperatively and were successfully treated. The postoperative NYHA functional class became II or less in all patients. For ASH, the My was effective in 9 patients except one earlier patient. For DIF, further consideration of surgical procedure might be required. For MID, a MVR is recommended.