Surgical Septal Myectomy for Hypertrophic cardiomyopathy. The Iranian Experience

2021 ◽  
pp. 021849232110445
Author(s):  
Alireza Alizadeh Ghavidel ◽  
Azin Alizadehasl ◽  
Ehsan Khalilipur ◽  
Ahmadali Amirghofran ◽  
Hanieh Nezhadbahram ◽  
...  
Keyword(s):  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Septal Myectomy ◽  
Septal Thickness ◽  
Long Term Follow Up ◽  
Left Ventricular Outflow ◽  
The Mean

Introduction Hypertrophic obstructive cardiomyopathy (HOCM) is a hereditary heart muscle disorder characterized by significant myocardial hypertrophy. we assessed perioperative and long-term follow-up data of Iranian HOCM patients who underwent SM in 2 pioneering centers. Methods Clinical data of patients with HOCM septal myectomy are collected. Thirty-day outcome and long-term follow-up data for recurrence of gradient and mortality are reported. Results Ninety-six patients in two different centers enrolled in the study. Most patients of 52 patients in center 1 were male (34/52 [65.3%]).and the mean age was of 36.7  ±  19 years. Syncope before admission was reported in 5.7%, the mean left ventricular ejection fraction on admission was 53  ±  8%, the mean left ventricular outflow tract gradient was 66.3  ±  20.4 mm Hg, and the mean preoperativeseptal thickness was 25.4  ±  6.7 mm. A redo SM was performed in 3 patients (5.8%), mitral valve repair in 5 patients (9.6%), and atrioventricular repair in 5 patients (9.6%). A residual systolic anterior motion was detected in 4 patients (7.7%), the mean postoperative septal thickness was 19  ±  6 mm (25.1% septal thickness reduction), and in-hospital mortality was 5.8% (n  =  3). A longer-term follow-up showed death in 3 patients (5.8%) and late recurrent left ventricular outflow tract obstruction in 1 patient. Conclusions Transaortic myectomy is an effective surgery with acceptable early and late mortality rates. Improvements in functional status are seen in almost all patients. Appropriate SM is crucial to a good clinical outcome. Long-term survival is excellent and cardiac sudden death is extremely rare after a good surgical treatment.

Aortic stenosis and left ventricular outflow tract obstruction

ESC CardioMed ◽  
2018 ◽  
pp. 807-810
Author(s):  
David Anderson
Keyword(s):  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Long Term Follow Up ◽  
Balloon Valvotomy ◽  
Left Ventricular Outflow

Left ventricular outflow tract obstruction can occur at subvalvar, valvar, and supravalvar levels. Severity and progression can be evaluated by echocardiography. Aortic valve stenosis can usually be relieved by balloon valvotomy, but some patients require surgery, either with valvotomy, valve replacement, or the Ross procedure. Sub- and supravalvar aortic stenosis require surgical management. Long-term follow-up of all patients is required.

scholarly journals Outcomes following transaortic septal myectomy in hypertrophic cardiomyopathy

2020 ◽  
Vol 7 (4) ◽  
pp. 1270
Author(s):  
Madhusudan Kummari ◽  
Amaresh Rao Malempati ◽  
Surya S. Gopal Palanki ◽  
Kaladhar Bomma
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Cardiac Death ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Septal Myectomy ◽  
Left Ventricular Outflow ◽  
History Of ◽  
The Mean

Background: The objective of the study was to evaluate effect of myectomy and its impact on survival for a period of one year and to identify the co-morbid conditions that would increase the risk of surgery.Methods: The study was conducted on the patients admitted in a single unit of department of cardiothoracic surgery, NIMS, Hyderabad during the period of 2014 to 2018. The study was a retrospective observational study. 21 patients were enrolled in the study after approval from institute ethics committee. All the patients between 7 to 70 years who underwent septal myectomy were included in the study.Results: Out of the 21 patients underwent modified Morrows myectomy 16 (76.2%) were male and 5 (23.8%) were female. The most common presenting symptom was dyspnea (81%), followed chest pain (76%), palpitations (62%) and syncope (38%). 5 (24%) patients had a family history of sudden cardiac death. Preoperative beta blockers were used by 15 (72%) patients. 11 patients had severe mitral regurgitation, out of which 8 patients underwent valve replacement and 3 underwent mitral valve repair. The mean preoperative left ventricular outflow tract obstruction gradient was 86.86 and the mean postoperative gradient was 23.47. 3 patients had implantable cardioverter defibrillator insertions. All patients had symptom relief.Conclusions: Surgical treatment of hypertrophic cardiomyopathy through transaortic septal myectomy is safe and effective method to relieve left ventricular outflow tract obstruction. Mitral valve replacement can be done for cases with structural defect of mitral valve. Early detection and intervention in patients with family history of sudden cardiac death would reduce the risk of death and ensure long term survival.

Aortic stenosis and left ventricular outflow tract obstruction

ESC CardioMed ◽  
2018 ◽  
pp. 807-810
Author(s):  
David Anderson
Keyword(s):  
Aortic Stenosis ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Long Term Follow Up ◽  
Balloon Valvotomy ◽  
Left Ventricular Outflow

Left ventricular outflow tract obstruction can occur at subvalvar, valvar, and supravalvar levels. Severity and progression can be evaluated by echocardiography. Aortic valve stenosis can usually be relieved by balloon valvotomy, but some patients require surgery, either with valvotomy, valve replacement, or the Ross procedure. Sub- and supravalvar aortic stenosis require surgical management. Long-term follow-up of all patients is required.

Verapamil therapy in infants with hypertrophic cardiomyopathy

1998 ◽  
Vol 8 (3) ◽  
pp. 310-319 ◽  
Author(s):  
Adrian M. Moran ◽  
Steven D. Colan
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Cardiac Catheterization Laboratory ◽  
Long Term Treatment ◽  
Left Ventricular Outflow

AbstractWe sought to evaluate the saftey and efficacy of acure and chronic treatment with verapamil infanta with hypertrophic cardimyopathy. Prior studies have shown an improvement in adluts with hypertrophiuc cardiomyophathy who were treated with verapamil. Acutely, it reduced the degree of left ventricular outflow tract abstruction. Chronic therapy was associated with an improvement in sysmptoms ans incresed long-term survial. To date, no data are available on the efficacy of this drug in infants with hypertrophic cardiomyopathy. We evaluated prospectively the safety and efficacy of verapamil in infants. The acute and chronic effects of verapamil on infants with an echocardiographic diagnosis of hypertrophic cardiomyopathy were evaluated at a single institution between 1980 and 1994, with long-term follow-up available until 1996. Acute effects of an intravenous bolus of 0.1 mg/kg and infusion at 0.007 mg/kg/min were evaluated, where possible, in the cardiac catheterization laboratory. Oral verapamil at 3–5 mg/kg/day was started after catheterization. Follow-up included serial clinical, echocardiographic and Holter monitoring. A total of 22 patients were studied, 17 having a presumed diagnosis of primary hypertrophic cardiomyopathy including three with Noonan's syndrome. Acute infusion of the drug was well tolerated by all, without adverse electrophysiological effects. Haemodynamic effects were consistent with a negative inotropic action with significant falls in cardiac index (4.6±1.2 to 4.1±0.9 l/min/m2), systolic blood pressure (88±16 to 82±14 mmHg) and gradient across the left ventricular outflow tract (nine patients 48.2±30.4 to 28.4±24.1 mmHg). End-diastolic pressure was unchanged (14.0±6.8 to 13.9±4.7 mmHg). Three patients with primary hypertrophic cardiomyopathy died (two while being treated). In the group with primary hypertrophic cardiomyopathy continuing with long-term treatment, follow-up revealed regression in two, progression in three (two died) and stability in 10. For those treated, there was a trend towards improvement in clinical status. Verapamil is well tolerated acutely in infants with hypertrophic cardiomyopathy. The outcome was considerably better in these patients compared with prior reports, though careful long-term assessment is needed.

Time and age dependent decrease of NT-proBNP after septal myectomy in hypertrophic obstructive cardiomyopathy

2017 ◽  
Vol 55 (10) ◽  
Author(s):  
Hao Cui ◽  
Xi Wu ◽  
Shuiyun Wang ◽  
Bing Tang ◽  
Changsheng Zhu ◽  
...  
Keyword(s):  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Dependent Manner ◽  
Factors Affecting ◽  
Septal Myectomy ◽  
Septal Thickness ◽  
Resting Pressure ◽  
Left Ventricular Outflow

AbstractBackground:NT-proBNP level is a predictive factor in hypertrophic cardiomyopathy patients, in which left ventricular outflow tract obstruction contributes to an increased NT-proBNP level. However, studies regarding the influence of septal myectomy on NT-proBNP level in hypertrophic obstructive cardiomyopathy are lacking.Methods:One hundred and eighty-two patients who underwent septal myectomy in Fuwai Hospital from May 2011 to March 2016 and were included in the present study. Preoperative and follow-up NT-proBNP was retrospectively collected. Correlation analysis was performed to determine the factors affecting preoperative NT-proBNP and postoperative decrease.Results:The cohort had a median age of 46.2 [IQR: 36.5–53.1] years, and 106 (58.2%) patients were male. NT-proBNP decreased to 816.5 [IQR: 400.3–1661.8] pg/mL from preoperative 1732.4 [IQR: 819–3296.5] pg/mL (p<0.001). Baseline NT-proBNP was correlated with gender (p<0.001), maximum septal thickness (p<0.001), and resting pressure gradient (p=0.006). The extent of NT-proBNP decrease was positively correlated with age (p<0.001), baseline NT-proBNP (p<0.001), follow-up time (p=0.020), and enlargement of the ascending aorta (p=0.019). NT-proBNP exhibited a persistent decrease after myectomy.Conclusions:Myectomy significantly reduced NT-proBNP level in hypertrophic obstructive cardiomyopathy patients, in which a time-dependent manner of decrease indicated myocardial remodeling of the heart after myectomy.

Peritricuspid annular prostate pellet

2021 ◽  
Vol 14 (2) ◽  
pp. e238076
Author(s):  
Bryan O'Sullivan ◽  
Richard Tanner ◽  
Peter Kelly ◽  
Gerard Fahy
Keyword(s):  
Right Ventricle ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Prostate Adenocarcinoma ◽  
Left Ventricular ◽  
Premature Ventricular Contractions ◽  
Left Ventricular Outflow ◽  
Metallic Object ◽  
The Right

A 75-year-old was treated for prostate adenocarcinoma with brachytherapy in September 2018. A routine follow-up chest radiograph 3 months later revealed a metallic object of the same dimensions as a brachytherapy pellet located in the right ventricle. Further imaging showed the brachtherapy pellet was located in the anterobasal right ventricular endocardium close to the tricuspid valve. Frequent asymptomatic premature ventricular contractions were observed with likely origin from the left ventricular outflow tract, an area remote from the site of the pellet. The patient remains asymptomatic and subsequent imaging shows that the position of the pellet has not changed.

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.

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