scholarly journals Transapical ultrasound-guided myectomy in midventricular obstructive hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Yutaka Yokota ◽  
Masanori Hirota ◽  
Takanori Suezawa ◽  
Takuya Kawabata ◽  
Yosuke Kuroko ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Ultrasound Guidance ◽  
Intraoperative Ultrasound ◽  
Left Ventricular ◽  
Ventricular Wall ◽  
Ultrasound Guided ◽  
Septal Myectomy ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Apical Aneurysm ◽  
Transapical Approach

In patients with midventricular obstructive hypertrophic cardiomyopathy (HCM), a transapical approach allows excellent exposure for midventricular myectomy. Although the ventriculotomy is required on the antero-lateral left ventricular wall, the minimal ventriculotomy would be ideal, especially for cases with concomitant apical aneurysm. We report a case of midventricular obstructive HCM with concomitant apical aneurysm. Through the minimal ventriculotomy within the aneurysm, the hypertrophic septum was successfully hollowed out under repeated ultrasound guidance. Intraoperative ultrasound guidance is useful for transapical septal myectomy in midventricular obstructive HCM.

scholarly journals Obstructive Hypertrophic Cardiomyopathy with Concomitant Mitral Regurgitation Treated with a Septal Myectomy and MV Repair: A Case Report

2018 ◽  
Vol 19 (2) ◽  
pp. 195-200
Author(s):  
Irena Mitevska ◽  
Elizabeta Srbinovska ◽  
Marijan Bosevski ◽  
Sasko Jovev ◽  
Omer Dzemali
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Medical Treatment ◽  
Beta Blocker ◽  
Systolic Function ◽  
Left Ventricular ◽  
Shortness Of Breath ◽  
Septal Myectomy ◽  
Obstructive Hypertrophic Cardiomyopathy

Abstract Case presentation Hypertrophic cardiomyopathy (HCM) is the most common and very heterogeneous genetic cardiac disease with a different clinical presentation and prognosis. The overall prevalence of the disease is estimated between 0.05-0.2% of the population. Left ventricular outflow obstruction at rest is present in about 20% of patients. Most of the patients have a normal life expectancy, however high risk patients might develop heart failure, atrial fibrillation, ventricular arrhythmias and sudden cardiac death. We present the case of 47-year-old Caucasian man who was hospitalized at our clinic with a history of chest pain and shortness of breath on physical activity in the last six months, which caused significant limitations of his life quality. Hypertrophic obstructive cardiomyopathy was diagnosed in 2011, when the patient was put on therapy with beta blocker. Transthoracic echocardiography revealed normal systolic function, presence of systolic anterior mitral valve motion (SAM) with moderate mitral regurgitation (MR). There was a significant concentric left ventricular hypertrophy predominantly located in the ventricular septum. The intraventricular gradient at rest was 77.8 mmHg. MRI of the heart confirmed significant LV hypertrophy with regions of fibrosis at the septum. The patient shortness of breath worsened progressively in the last month (NYHA III) despite optimized medical treatment with maximal beta blocker dose. Surgical approach with septal myectomy was performed with mitral valve repair. There were no operative complications, with excellent postoperative recovery and complete symptoms resolution. Control Doppler echocardiograms revealed LVOT rest gradient reduction to 34 mmHg. The good operative results were still present 9 months after the intervention. Our case confirmed that septal myectomy with MV repair is an excellent treatment approach in young patient with obstructive hypertrophic cardiomyopathy and mitral valve involvement refractory to medical treatment.

scholarly journals Рекомендации Американской ассоциации сердца / Американского колледжа кардиологии 2020 года по диагностике и лечению пациентов с гипертрофической кардиомиопатией: что нового?

2021 ◽  
Vol 25 (2) ◽  
pp. 108
Author(s):  
С. А. Будагаев ◽  
А. В. Афанасьев ◽  
А. В. Богачев-Прокофьев ◽  
А. С. Залесов ◽  
М. А. Овчаров
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Conflict Of Interest ◽  
Severe Heart Failure ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Alcohol Septal Ablation ◽  
Ventricular Ejection Fraction ◽  
Septal Myectomy ◽  
Obstructive Hypertrophic Cardiomyopathy

<p>On 22 December 2020, <em>Circulation</em> published the new American College of Cardiology / American Heart Association guidelines for the diagnosis and treatment of patients with hypertrophic cardiomyopathy. The most important guidelines were those concerning pharmacological and invasive methods of treating symptomatic patients with obstruction of the left ventricular outlet. Considering the most recent clinical studies, the indications for invasive methods of treatment have expanded to include septal myectomy and alcohol septal ablation. A separate section in the guidelines has been devoted to the management of non-obstructive hypertrophic cardiomyopathy with preserved left ventricular ejection fraction. The recommendations for patients with hypertrophic cardiomyopathy with atrial fibrillation, ventricular arrhythmias and severe heart failure have been revised.</p><p>Received 26 March 2021. Revised 12 May 2021. Accepted 13 May 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev<br />Data collection and analysis: S.A. Budagaev, M.A. Ovcharov<br />Drafting the article: S.A. Budagaev, A.V. Afanasyev, A.S. Zalesov<br />Critical revision of the article: A.V. Bogachev-Prokophiev<br />Final approval of the version to be published: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev, A.S. Zalesov, <br />M.A. Ovcharov</p>

Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

2021 ◽  
pp. 021849232110561
Author(s):  
Alexandr V. Afanasyev ◽  
Alexandr V. Bogachev-Prokophiev ◽  
Sergei I. Zheleznev ◽  
Anton S. Zalesov ◽  
Sergei A. Budagaev ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Pacemaker Implantation ◽  
Heart Association ◽  
Left Ventricular ◽  
Left Ventricular Wall ◽  
Ventricular Wall ◽  
Alcohol Septal Ablation ◽  
Safety And Efficacy ◽  
Septal Myectomy ◽  
Early Results

Background We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy. Methods We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution. Results The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02–11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent. Conclusions The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.

RF42 LONG TERM RESULTS OF SEPTAL MYECTOMY IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY

2018 ◽  
Vol 19 ◽  
pp. e76-00
Author(s):  
G. Saitto ◽  
F. Grimaldi ◽  
A. Varrica ◽  
A. Biondi ◽  
A. Garatti ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Long Term Results ◽  
Septal Myectomy ◽  
Obstructive Hypertrophic Cardiomyopathy

Left Ventricular Apical Aneurysm in a Patient with Hypertrophic Cardiomyopathy Diagnostic and Management Dilemmas

2019 ◽  
Vol 03 (03) ◽  
Author(s):  
Parthena Theodoridou ◽  
Despoina Masmanidou ◽  
Panagiotis Kousidis ◽  
Panagiotis Roumelis ◽  
Anastasios Tsarouchas ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular ◽  
Apical Aneurysm
Sign in / Sign up

Export Citation Format

Share Document