scholarly journals Non-pharmaceutical Interventions for Hypertrophic Cardiomyopathy: A Mini Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Miaomiao He ◽  
Jie Qiu ◽  
Yang Bai ◽  
Yan Wang ◽  
Mei Hu ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Invasive Treatment ◽  
Septal Myectomy ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow ◽  
Pharmaceutical Interventions

Hypertrophic cardiomyopathy is an inherited cardiovascular disease, and 70% of patients have left ventricular outflow tract obstruction. Ventricular septal myectomy has been the gold standard treatment for most patients with refractory symptoms. Due to higher mortality associated with medical facilities with less experience, alcohol septal ablation has been accepted as an alternative to conventional surgical myectomy. It offers lower all-cause in-hospital complications and mortality, which could be potentially more preferable for patients with serious comorbidities. In recent years, radiofrequency ablation, providing another option with reproducibility and a low risk of permanent atrioventricular block, has become an effective invasive treatment to relieve left ventricular outflow tract obstruction. Moreover, substantial progress has been made in gene therapy for hypertrophic cardiomyopathy. The principal objective of this review is to present recent advances in non-pharmaceutical interventions in hypertrophic cardiomyopathy.

Secondary chordal resection with septal myectomy for treatment of symptomatic obstructive hypertrophic cardiomyopathy

2021 ◽  
Author(s):  
Eilon Ram ◽  
Ehud Schwammenthal ◽  
Rafael Kuperstein ◽  
Tamer Jamal ◽  
Eyal Nahum ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Interquartile Range ◽  
Septal Myectomy ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

Abstract OBJECTIVES Left ventricular outflow tract obstruction causes symptoms of heart failure in most patients with hypertrophic cardiomyopathy. Resection of the secondary mitral valve (MV) chordae has recently been shown to move the MV apparatus posteriorly, thereby eradicating the outflow gradient. The aim of this study was to evaluate whether secondary chordal resection concomitant to septal myectomy improves outcomes. METHODS Between 2005 and 2020, a total of 165 patients underwent septal myectomy without MV repair or replacement in our Medical Center. Secondary MV chordal resection was performed in 60 patients, and their outcomes were compared with those of the remaining 105 patients who did not undergo chordal resection (controls). Mean age was 61 ± 13 and 58 ± 16 years, respectively (P = 0.205). RESULTS There were no in-hospital deaths throughout the entire cohort. Of those patients who underwent secondary chordal resection, New York Heart Association functional class decreased from 3 (interquartile range 2–3) preoperatively to 1 (interquartile range 1–2) postoperatively (P < 0.001), and resting outflow gradient decreased from 91 ± 39 mmHg to 13 ± 8 mmHg (86% change, P < 0.001). Compared with controls, patients who underwent secondary chordal resection had a significant lower resting outflow gradient at follow-up (14 ± 7 mmHg vs 21 ± 15 mmHg, P = 0.002). The rate of moderate or more than moderate mitral regurgitation at 5 years was 2% in the secondary chordal resection group and 5% in the controls (hazard ratio 1.05, confidence interval 0.11–10.32; P = 0.965). CONCLUSIONS In this observational study, we report that secondary chordal resection concomitant to septal myectomy for left ventricular outflow tract obstruction is safe, relieves heart failure symptoms and reduces left ventricular outflow tract gradient in appropriately selected patients.

Hypertrophic cardiomyopathy: invasive management of left ventricular outflow tract obstruction

ESC CardioMed ◽  
2018 ◽  
pp. 1459-1462
Author(s):  
Steve R. Ommen
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Left Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Success Rates ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy ◽  
Ventricular Outflow Tract Obstruction ◽  
Left Ventricular Outflow

Left ventricular outflow tract obstruction in hypertrophic cardiomyopathy can result in considerable symptoms. While pharmacological therapies are the first-line treatment for most patients, there are invasive therapies that have shown excellent success in relieving these drug-refractory symptoms. Surgical septal myectomy and percutaneous alcohol septal ablation, each with relative merits and risks, offer high success rates when performed in the context of specialized hypertrophic cardiomyopathy programmes.

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