Outcome of patients with hypertrophic obstructive cardiomyopathy after percutaneous transluminal septal myocardial ablation and septal myectomy surgery

2002 ◽  
Vol 11 (2) ◽  
pp. 56-57
Author(s):  
J.X. Qin ◽  
T. Shiiota ◽  
H.M. Lever
Keyword(s):  
Hypertrophic Obstructive Cardiomyopathy ◽  
Septal Myectomy ◽  
Percutaneous Transluminal

scholarly journals Successful Percutaneous Septal Alcohol Ablation After Surgical Myectomy

2010 ◽  
Vol 10 (3) ◽  
pp. 218-222
Author(s):  
Mehmed Kulić ◽  
Muhamed Spužić ◽  
Elnur Tahirović ◽  
Šejla Šehović ◽  
Vedad Mujačić ◽  
...  
Keyword(s):  
Left Ventricular Outflow Tract ◽  
Percutaneous Treatment ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Alcohol Ablation ◽  
Septal Myectomy ◽  
Left Ventricular Outflow ◽  
Surgical Myectomy ◽  
Percutaneous Transluminal

Hypertrophic obstructive cardiomyopathy (HOCM) is a primary, usually familial and genetically fixed myocardial hypertrophy, with dynamic left ventricular outflow tract obstruction. An alternative to surgical myectomy in the treatment of severe, drug refractory, HOCM is percutaneous transluminal septal myocardial ablation (PTSMA). We report a case of 24 year old female patient who had the first septal myectomy but because of progression of her disease, the percutaneous treatment of hypertrophic obstructive cardiomyopathy was performed. A year after the PTSMA the patient was without of symptoms.

Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

2012 ◽  
Vol 15 (5) ◽  
pp. 251
Author(s):  
Changqing Gao ◽  
Chonglei Ren ◽  
Cangsong Xiao ◽  
Yang Wu ◽  
Gang Wang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Surgical Procedures ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Septal Myectomy ◽  
The Mean

<p><b>Background:</b> The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>Methods:</b> Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.</p><p><b>Results:</b> All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (<i>P</i> = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (<i>P</i> = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.</p><p><b>Conclusions:</b> Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.</p>

Extended septal myectomy and left ventricular outflow tract intervention for hypertrophic obstructive cardiomyopathy

2021 ◽  
Keyword(s):  
Left Ventricular Outflow Tract ◽  
Therapeutic Option ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Septal Myectomy ◽  
Inherited Cardiomyopathy ◽  
Left Ventricular Outflow ◽  
Tailored Approach

Hypertrophic obstructive cardiomyopathy is the most common inherited cardiomyopathy. Septal myectomy is a low-risk operation and remains the first septal reduction therapeutic option. We present a patient with hypertrophic obstructive cardiomyopathy requiring extended septal myectomy and concomitant left ventricular outflow tract intervention. In addition to septal reduction therapy, this patient also underwent anterior mitral valve plication, trigonal release, and secondary chordal division to relieve the obstruction. A tailored approach to hypertrophic obstructive cardiomyopathy with a comprehensive left ventricular outflow tract intervention is necessary to ensure the best hemodynamic outcome. Preoperative heart failure and recurrent syncope fully resolved after this intervention.

scholarly journals Application of mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: A single-center experience with 168 cases

2020 ◽  
Author(s):  
Qiang Ji ◽  
YuLin Wang ◽  
Ye Yang ◽  
Hao Lai ◽  
WenJun Ding ◽  
...  
Keyword(s):  
New York ◽  
Pacemaker Implantation ◽  
Heart Association ◽  
Technical Difficulty ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Surgical Instruments ◽  
Septal Myectomy ◽  
Refractory Symptoms ◽  
Early Results

Abstract Background: Septal myectomy has been a standard treatment option for patients with hypertrophic obstructive cardiomyopathy (HOCM) and drug refractory symptoms. However, there are only a few experienced myectomy centers in the world so far, mainly because of high technical difficulty of myectomy. From our clinical experience, the use of the mini-invasive surgical instruments during myectomy may be beneficial to reduce the technical difficulty. This study reports the preliminary experience regarding transaortic septal myectomy using mini-invasive surgical instruments for the treatment of patients with HOCM and drug refractory symptoms, and evaluates the early results following myectomy.Methods Between March 2016 and March 2019, consecutive HOCM patients were included in this analysis who underwent isolated transaortic septal myectomy using the mini-invasive surgical instruments. Intraoperative, in-hospital and follow-up results were analyzed.Results A total of 168 eligible patients (83 males, mean 56.8 ± 12.3 years) were included. Midventricular obstruction was recorded in 7 (4.2%) patients. All included patients underwent transaortic septal myectomy with a mean aortic cross-clamping time of 36.0 ± 8.1 minutes. Nine (5.4%) patients received repeat aortic cross-clamping during surgery. Surgical mortality was 0.6%. Five (3.0%) patients developed complete atrioventricular block and required permanent pacemaker implantation. The median follow-up time was 6 months. No follow-up deaths occurred with a significant improvement in New York Heart Association functional status. The maximum gradients decreased sharply from the preoperative value (11.6 ± 7.4 mmHg vs. 94.4 ± 2 2.6 mmHg, p<0.001). The median degree of mitral regurgitation fell to 1.0 (vs. 3.0 preoperatively, p<0.001) with a significant reduction in the proportion of moderate or more regurgitation (1.2% vs. 57.7%, p<0.001).Conclusions The use of the mini-invasive surgical instruments may be beneficial to reduce the technical difficulty of transaortic septal myectomy procedure. Transaortic septal myectomy using the mini-invasive surgical instruments may be associated with favorable results.

scholarly journals Image-based computational hemodynamics analysis of systolic obstruction in hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Ivan Fumagalli ◽  
Piermario Vitullo ◽  
Roberto Scrofani ◽  
Christian Vergara
Keyword(s):  
Blood Flow ◽  
Hypertrophic Cardiomyopathy ◽  
Stokes Equations ◽  
Pathological Condition ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Navier Stokes ◽  
Cine Mri ◽  
Computational Hemodynamics ◽  
Septal Myectomy ◽  
Dynamics Simulations

Hypertrophic Cardiomyopathy (HCM) is a pathological condition characterized by an abnormal thickening of the myocardium. When it affects the medio-basal portion of the septum, it is named Hypertrophic Obstructive Cardiomyopathy because it induces a flow obstruction in the left ventricle outflow tract, which may compromise the cardiac function and possibly lead to cardiac death. In this work, we investigate the hemodynamics of different HCM patients by means of computational hemodynamics, aiming at quantifying the effects of this pathology on blood flow and pressure gradients and thus providing clinical indications that may help diagnosis and the design of surgical treatment (septal myectomy). To this aim, we employ an enhanced version of an image-based computational pipeline proposed in a previous work, integrating fluid dynamics simulations with geometrical and functional data reconstructed from standard cine-MRI acquisitions. Blood flow is modelled as an incompressible Newtonian fluid, The corresponding Navier-Stokes equations are solved in a moving domain obtained from cine-MRI, whereas the valve leaflets are accounted for by a resistive method.

scholarly journals Short-term outcomes of surgical atrial ablation and septal myectomy

2021 ◽  
Vol 25 (3) ◽  
pp. 51
Author(s):  
A. S. Zalesov ◽  
A. V. Bogachev-Prokophiev ◽  
A. V. Afanasyev ◽  
R. M. Sharifulin ◽  
A. V. Sapegin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hypertrophic Cardiomyopathy ◽  
Sinus Node ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Radiofrequency Energy ◽  
Short Term ◽  
Surgical Ablation ◽  
Septal Myectomy ◽  
Atrial Ablation ◽  
Obstructive Hypertrophic Cardiomyopathy

<p><strong>Background.</strong> Hypertrophic cardiomyopathy is one of the most common types of cardiomyopathy. The appearance of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is associated with significant clinical worsening. Outcomes of surgical ablation and septal myectomy in these patients are limited.<br /><strong>Aim.</strong> This retrospective study aimed to evaluate short-term outcomes of concomitant surgical ablation and septal myectomy in patients with obstructive hypertrophic cardiomyopathy and atrial fibrillation.<br /><strong>Methods.</strong> Fifty-five patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent concomitant surgical ablation and septal myectomy between 2014 and 2019 were analysed. Patients with paroxysmal atrial fibrillation predominantly underwent left atrial ablation, and those with nonparoxysmal atrial fibrillation predominantly underwent the Maze IV procedure. Surgical ablation was performed using cryoablation alone (83.6%) or in combination with radiofrequency energy (16.4%).<br /><strong>Results.</strong> Hospital mortality was 1.8%. Incidence of major adverse events was 3.6%. Sinus node dysfunction and atrioventricular block occurred in 7.3% and 1.8% of patients, respectively. Bleeding requiring revision occurred in 2 (3.6%) patients. Forty-nine (89.1%) patients had stable sinus rhythm and five (9.1%) were on dual-chamber pacemaker stimulation at the time of discharge.<br /><strong>Conclusion.</strong> Concomitant septal myectomy and surgical ablation are feasible and safe in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.</p><p>Received 5 April 2021. Revised 16 May 2021. Accepted 17 May 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: A.S. Zalesov, A.V. Bogachev-Prokophiev<br />Data collection and analysis: A.S. Zalesov, S.A. Budagaev, A.V. Sapegin<br />Statistical analysis: A.S. Zalesov, A.V. Afanasyev, R.M. Sharifulin<br />Drafting the article: A.S. Zalesov<br />Critical revision of the article: A.V. Bogachev-Prokophiev, S.I. Zheleznev, I.I. Demin<br />Final approval of the version to be published: A.S. Zalesov, A.V. Bogachev-Prokophiev, A.V. Afanasyev, R.M. Sharifulin, A.V. Sapegin, S.A. Budagaev, S.I. Zheleznev, I.I. Demin</p>

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