Abstract 15426: Comparison of Multimodality Imaging in Mitral Leaflet Lengths in Patients Undergoing Surgical Myectomy: A Prospective Study in Hypertrophic Obstructive Cardiomyopathy Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Agostina M Fava ◽  
Anand Mehta ◽  
Barbara Bittel ◽  
Andrew Bauer ◽  
Zoran B Popovic ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Multimodality Imaging ◽  
Imaging Techniques ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Posterior Leaflet ◽  
Anterior Leaflet ◽  
Average Deviation ◽  
Basal Septum

Introduction: In hypertrophic obstructive cardiomyopathy (HOCM), mitral valve (MV) leaflets in often contribute to left ventricular outflow tract obstruction (LVOTO). Hence, MV assessment is crucial during surgical planning. 2 or 3-dimensional transesophageal echocardiography (2D or 3D TEE) & cardiac magnetic resonance (CMR) are used to measure MV length. Hypothesis: We sought to compare MV leaflet lengths using intraoperative TEE [2D, zoom 3D, automatic quantification of mitral valve (AMVQ)], & preoperative CMR. Methods: We prospectively studied 50 HOCM patients (59±12 years, 46% men, basal septum 18±5 mm, LVOT gradient 87 ±56 mmHg) undergoing surgical relief of LVOTO. We compared MV leaflet length on a) long-axis 2DTEE b) 3DTEE using multiplanar reconstruction c) AMVQ, EchoPAC, General Electric & d) CMR. Results: Mean anterior leaflet lengths (mm) were as follows: 2D TEE (3.3 ±0.3), 3DTEE (2.9±0.5), CMR (3.1±0.4), & AMVQ (2.9±0.5). Mean posterior leaflet lengths were 1.7±0.3, 1.7±0.4, & 1.7±0.2 & 1.9±0.4 mm, respectively. Assuming 3DTEE as the gold standard, the closest correlation for anterior leaflet was with CMR (average overestimation by CMR of 0.5 mm [root mean square deviation or RMSE% 17]), intermediate correlation with 2DTEE (average deviation of 0.6 mm [RMSE%:21]) & no correlation with AMVQ (deviation of 0.7mm [RMSE% 24]), Fig 1A-C & 2A-C. No correlation was found for posterior leaflet,Fig 1D-F & 2D-F. Conclusions: There are significant differences in measuring MV lengths using different imaging techniques. In HOCM patients undergoing surgery, precise measurement of MV leaflet lengths is crucial & extrapolation from one technique to other is not recommended.

Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

2019 ◽  
Vol 14 (3) ◽  
pp. 281-285 ◽  
Author(s):  
Burak Onan ◽  
Ersin Kadirogullari ◽  
Zeynep Kahraman ◽  
Onur Sen
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Da Vinci Surgical System ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Valve Repair ◽  
Septal Myectomy ◽  
Mitral Repair

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

scholarly journals Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy with Concomitant Mitral Valve Abnormalities: A Cohort of 26 Cases

2018 ◽  
Vol 21 (6) ◽  
pp. E443-E447
Author(s):  
Bang-rong Song ◽  
Yanlong Ren ◽  
Hong-jia Zhang
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Systolic Anterior Motion ◽  
Left Ventricular Outflow ◽  
Mitral Apparatus

Background: We sought to analyze the pathological characteristics of hypertrophic obstructive cardiomyopathy (HOCM) with concomitant mitral valve abnormalities and to discuss the surgical treatment strategies. Methods: The clinical data of 26 HOCM patients treated from January 2014 to March 2016 were retrospectively analyzed. There were 19 males and 7 females with a mean age of 47 ± 16 years (range, 10-70 years). Echocardiography showed HOCM, systolic anterior motion of the mitral apparatus, and concomitant mitral regurgitation. Modified Morrow procedure with expanded resection area was performed in 21 patients. Concomitant mitral valvuloplasty was performed in 4 patients, coronary artery bypass grafting was performed in one patient, and aortic valve replacement was performed in one patient. Echocardiography was performed intraoperatively at postoperative 1 week and at postoperative 1 year to evaluate the left ventricular obstruction and the mitral regurgitation. Results: The left ventricular outflow tract gradient, left ventricular outflow tract velocity, septal thickness, and mitral regurgitation area decreased significantly at postoperative 1 week and 1 year in comparison with the baseline (all P < .001). The postoperative mitral regurgitation and systolic anterior motion of the mitral apparatus were completely abolished or significantly relieved. Only one patient had moderate mitral regurgitation of 7 cm2 after the surgery. At postoperative 1 year, all patients were asymptomatic, and the quality of life was significantly improved. The New York Heart Association (NYHA) class was I-II. Echocardiography showed good anatomy and function of the mitral valve. Conclusions: Concomitant mitral valve abnormality is not uncommon in HOCM. Septal myectomy can adequately expand the left ventricular outflow tract and abolish mitral regurgitation and systolic anterior motion of the mitral apparatus. Concomitant mitral valvuloplasty is indicated for severe congenital abnormalities or secondary lesions of the mitral valve, and the outcomes are satisfactory.

scholarly journals So Many Ways…

2021 ◽  
Author(s):  
Fayyaz Hashmi
Keyword(s):  
Mitral Valve ◽  
Excellent Result ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Pericardial Patch ◽  
Mitral Valve Leaflet ◽  
Septal Myectomy ◽  
Autologous Pericardial Patch ◽  
Left Ventricular Outflow

Enlargement of left ventricular outflow tract using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach for the hypertrophic obstructive cardiomyopathy Zhang et al (1) describe their experience in septal myectomy for hypertrophic obstructive cardiomyopathy. Of 247 consecutive cases with HOCM treated during 2016-2019 with a variety of techniques, this report is on 16 patients who underwent trans-mitral septal myectomy and enlargement of left ventricular outflow with an autologous pericardial patch in transverse configuration. The technique reportedly decreased the gradient from average 90+ to 10+ mm Hg and resolved systolic anterior leaflet motion in all with only mild residual mitral regurgitation. There were no deaths or any other major complications in this group. It is a small group of patients with excellent result but no definitive conclusion can be drawn regarding validity of the technique from this study. The controversy remains regarding the approach, trans-aortic vs. trans-mitral and whether leaflets should be left alone, plicated or lengthened as well as whether mitral valve should be repaired or replaced in addition to septal myectomy. One certainty remains, extended myectomy done either way, is the foundation of the surgical treatment of hypertrophic cardiomyopathy.

scholarly journals Enlargement Of Left Ventricular Outflow Tract Using An Autologous Pericardial Patch For The Anterior Mitral Valve Leaflet And Septal Myectomy Through Trans-mitral Approach For The Treatment Of Hypertrophic Obstructive Cardiomyopathy

2020 ◽  
Author(s):  
Hongqiang Zhang ◽  
Kai Zhu ◽  
Fanshun Wang ◽  
Xiaoning Sun ◽  
Shouguo Yang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Pericardial Patch ◽  
Valve Leaflet ◽  
Mitral Valve Leaflet ◽  
Septal Myectomy ◽  
Autologous Pericardial Patch ◽  
Left Ventricular Outflow

Abstract Background: Modified Morrow procedure is the gold standard of surgical intervention for hypertrophic obstructive cardiomyopathy (HOCM). However, there are certain cases without clear exposure through the traditional trans-aortic approach; we therefore described a trans-mitral approach by enlarging left ventricular outflow tract (LVOT) using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy. We aimed to retrospectively analyze this series of patients to reveal its safety and efficiency.Methods: We retrospectively analyzed 16 HOCM patients underwent enlargement of LVOT using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach in our center from January, 2016 to December, 2019. Baseline characteristics, operative details and postoperative data were extracted from our hospital medical records. Results: Of the 16 patients, there was no operative mortality. No new onset atrial fibrillation, no new onset stroke with symptoms, no permanent pacemaker implantation and no ventricular septal defects formation were observed during operation and three months follow-up. The peak pressure gradient of LVOT decreased from 97.56±23.81 mmHg to 7.56±2.13 mmHg (P < 0.01) after operation and 10.19±2.93 mmHg (P < 0.01) three months after operation. The average aortic cross-clamp time was 54.56±6.10 mins (range, 48 to 69 minutes). The systolic anterior motion (SAM) sign disappeared uneventfully in all cases. No patients had more than moderate MR.Conclusions: Enlargement of LVOT using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach is feasible and reliable for the treatment of certain types of HOCM cases.Trial registration: Not applicable.

P893Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: experience at a reference center in Chile

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Verdugo ◽  
P Cataldo ◽  
C Dauvergne ◽  
J Sandoval
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Average Length ◽  
Beta Blockers ◽  
Nyha Class ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Alcohol Injection ◽  
Septal Thickness

Abstract Background Depending on the severity of septal hypertrophy and mitral valve derangements, patients with hypertrophic cardiomyopathy may develop left ventricular outflow tract (LVOT) obstruction and mitral regurgitation, which have major impact on symptoms and prognosis.Surgical myomectomy has been considered standard treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite medical therapy.Alcohol septal ablation (ASA), is a minimally invasive therapy for HOCM. Purpose Our aim was to assess short and long term outcomes and complications of ASA performed to symptomatic HOCM patients in our center. Methods We performed a retrospective observational study of patients undergoing ASA for HOCM between January 2002 and September 2018. According to local protocol, clinical evaluation and echocardiography were performed at baseline and 6 months after ASA. Local databases were reviewed, along with direct patient contact when required. Results ASA was performed in 73 patients with HOCM.Mean age was 57.5±12.8 years; 63% were male; 83.5% were on III-IV NYHA class, 32.9% had syncope; 12.3% had family history of sudden cardiac death, 93.6% received beta blockers, 6.8% had implantable cardioverter defibrillator.Mean alcohol injection per procedure was 2.45±1.03 cc. Invasive resting gradients were acutely reduced from 61.2±36.3 mmHg to 23.4±27.5 mmHg (p<0.001), and dynamic gradients from 106.5±37.3 mmHg to 31.0±28.0 mmHg (p<0.001). Hemodynamic success (reduction in resting gradient to <30 mmHg or dynamic gradient >50%) was achieved in 82.2% patients. We observed improvements in mitral regurgitation at ventriculography (Figure 1A, p<0.001), a decline of ≥1 severity degree was noticed in 53 patients (72.6%). Maximal creatine kinase after ASA was 2055±851 U/l. Average length of hospitalization was 4.4±5.0 days. Reablation was performed in 12 patients, 7 were planned staged procedures and 5 due to unsuccessful ASA. We observed no in-hospital mortality. Permanent pacemaker were implanted in 9 patients. Vascular access complications occurred in 3 patients. Coronary dissection and cardiac tamponade occurred in 1 patient respectively. Complications were more frequent after reablation (50% vs 17%, p<0.01).At 6 months, we observed improvements in NYHA class (Figure 1B, p<0.001), a decline of ≥1 NYHA class was found in 68 patients (93.2%). Echocardiographic assessment exposed reductions in septal thickness (25.0±5.5 vs 17.1±5.3 mm, p<0.001), LVOT gradients (86.7±27.3 vs 38.4±15.1 mmHg, p<0.001) and systolic anterior motion of the mitral valve prevalence (61.6% vs 27.4%, p=0.002). At 12 months, we detected only 1 death due to COPD.No cardiovascular deaths were noted in patients achieving 5 years of follow-up (n=49). Figure 1 Conclusion ASA was a safe and effective procedure in symptomatic HOCM, resulting in reductions of septal thickness, LVOT gradients and mitral regurgitation severity, as well as an improvement in NYHA class.

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