Outcomes following transaortic septal myectomy in hypertrophic cardiomyopathy

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.

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Impact of Incidental Amyloidosis on the Prognosis of Patients With Hypertrophic Cardiomyopathy Undergoing Septal Myectomy for Left Ventricular Outflow Tract Obstruction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2014.07.058 ◽

2014 ◽

Vol 114 (9) ◽

pp. 1396-1399 ◽

Cited By ~ 10

Author(s):

Meghana R.K. Helder ◽

Hartzell V. Schaff ◽

Rick A. Nishimura ◽

Bernard J. Gersh ◽

Joseph A. Dearani ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Septal Myectomy ◽

Ventricular Outflow Tract Obstruction ◽

Left Ventricular Outflow

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Surgical Septal Myectomy for Hypertrophic cardiomyopathy. The Iranian Experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/02184923211044582 ◽

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.

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The relationship between systolic anterior motion of the mitral valve and the left ventricular outflow tract Doppler in hypertrophic cardiomyopathy

American Heart Journal ◽

10.1016/0002-8703(91)90286-q ◽

1991 ◽

Vol 122 (6) ◽

pp. 1671-1682 ◽

Cited By ~ 13

Author(s):

Chung-Sheng Lin ◽

Kuo-Shuen Chen ◽

Ming-Cheng Lin ◽

Men-Chin Fu ◽

Shu-Mei Tang

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Mitral Valve ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Systolic Anterior Motion ◽

Left Ventricular Outflow ◽

The Relationship

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Alcohol septal ablation for recurrent left ventricular outflow tract obstruction after combined myectomy and mitral valve repair in hypertrophic cardiomyopathy

International Journal of Cardiology ◽

10.1016/j.ijcard.2013.03.102 ◽

2013 ◽

Vol 167 (2) ◽

pp. e30-e32

Author(s):

Angelos G. Rigopoulos ◽

Barbara Pfeiffer ◽

Christoph Schimmer ◽

Jürgen Illnitzky ◽

Rainer Leyh ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Left Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Valve Repair ◽

Alcohol Septal Ablation ◽

Left Ventricular Outflow

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Membranous septal aneurysm in a child with Noonan syndrome and hypertrophic cardiomyopathy

10.22541/au.161496450.06346078/v1 ◽

2021 ◽

Author(s):

PRIYADARSHINI ARUNAKUMAR ◽

Usha MK ◽

RAMYA S ◽

Jayaranganath M

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Mitral Valve ◽

Noonan Syndrome ◽

Left Ventricular Outflow Tract ◽

Interventricular Septum ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Mitral Leaflet ◽

Left Ventricular Outflow

A four year old boy was diagnosed with hypertrophic cardiomyopathy with moderate degree of obstruction of the left ventricular outflow tract, secondary to asymmetric septal hypertrophy and no features of congestive heart failure, at the age of the 7 months. He was also found to have myxomatous mitral valve, systolic anterior motion of anterior mitral leaflet and moderate mitral regurgitation. There was no evidence of ventricular septal defect at this point in time.In view of phenotypic features suggestive of Noonan syndrome, he underwent genetic evaluation with target gene sequencing and was detected to have a novel heterozygous mutation in exon 13 of LZTR 1 (Leucine- zipper-like transcriptional regulator 1) gene. Echocardiogram on follow up showed increase in left ventricular outflow tract obstruction and appearance of an aneurysm in the membranous portion of interventricular septum. There were no features of right ventricular outflow obstruction, tricuspid regurgitation or aortic regurgitation. The appearance of the membranous septal aneurysm may be related to the direction of jet arising from the point of contact of the anterior mitral leaflet with the hypertrophied basal septum and hitting this part of the interventricular septum. It is an unusual mechanism for formation of membranous septal aneurysm, given its absence in the earlier echocardiograms and absence of any left to right shunt across the aneurysm. He has been initiated on beta blockers due to severe left ventricular outflow tract obstruction and is planned for septal myomectomy, resection of membranous septal aneurysm and mitral valve repair.

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