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Septal myectomy in hypertrophic obstructive cardiomyopathy: late results with stress echocardiography
1Cardiovascular Surgery Clinic, Türkiye Yüksek Ihtisas Hospital, Ankara, Turkey. hk04-k@servis.net.tr
Insights
Septal myectomy is a safe and effective treatment for hypertrophic obstructive cardiomyopathy, offering excellent long-term functional outcomes for survivors. This procedure significantly reduces septal thickness and outflow gradients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) presents challenges in long-term management.
- Septal myectomy is a surgical option for HOCM.
- Assessing long-term functional capacity post-myectomy is crucial.
Purpose of the Study:
- To evaluate the long-term functional capacity of HOCM survivors after septal myectomy.
- To assess the efficacy of septal myectomy using dobutamine stress echocardiography.
Main Methods:
- Retrospective analysis of 69 HOCM patients undergoing septal myectomy (1975-1996).
- Evaluation of early mortality and long-term follow-up of hospital survivors (mean 43.8 months).
- Postoperative functional capacity assessed, with dobutamine stress echocardiography in 43.9% of patients.
Main Results:
- Significant reduction in interventricular septum thickness (1.99 cm to 1.55 cm) and posterior wall thickness.
- Marked decrease in left ventricular outflow systolic gradients (78.4 mm Hg to 17.9 mm Hg).
- No late deaths reported; mean postoperative functional capacity was 1.47.
Conclusions:
- Septal myectomy is a safe procedure for HOCM.
- The surgery yields excellent long-term clinical and functional results.
- Dobutamine stress echocardiography aids in assessing functional capacity post-myectomy.
Background:
This study was performed to assess the functional capacity of the survivors of septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy in long-term follow-up as assessed by dobutamine stress echocardiography.
Methods:
Sixty-nine patients with hypertrophic obstructive cardiomyopathy underwent septal myectomy between 1975 and 1996. The mean age was 25.4 +/- 13.6 years (range, 6-58 years), and 10 of the patients were women. The early mortality was 4.3%. Hospital survivors (95.7%) were followed up for a mean of 43.8 +/- 28.7 months (range, 6-114 months).
Results:
The postoperative mean functional capacity of the group was 1.47 +/- 0.56. No late deaths were reported. Forty-nine patients (74.2%) were evaluated with standard echocardiographic techniques, and 29 (43.9%) patients underwent dobutamine stress echocardiography. There was a significant decrease in the thickness of the interventricular septum after surgery. The mean preoperative and postoperative septal thickness was 1.99 +/- 0.59 cm (range, 1.3-3.8 cm) and 1.55 +/- 0.41 cm (range, 0.96-2.8 cm), respectively (p < 0.004). The mean posterior wall thickness was significantly less than the preoperative value (p = 0.008) and the left ventricular end-diastolic diameter was slightly greater in the postoperative measurements, but the difference was not significant (p = 0.162). Postoperative left ventricular outflow systolic gradients were reduced significantly when compared with preoperative values (preoperative mean, 78.4 +/- 33.6 mm Hg, range, 50-212 mm Hg versus postoperative mean, 17.9 +/- 15.9 mm Hg: range, 0-40 mm Hg; p < 0.0001).
Conclusion:
Septal myectomy for patients with hypertrophic obstructive cardiomyopathy is a safe procedure with excellent clinical and functional results in the long-term follow-up.