Abstract
Objective: To evaluate the surgical clinical results of hypertrophic obstructive cardiomyopathy. Methods: We retrospectively collected data on 24 patients who underwent surgical management in the past ten years in two hospitals in China and Madras Medical Mission in India. Myomectomy was carried out on all patients. Among them 3 patients underwent mitral valve replacement; 2 patients underwent mitral valve repair (anterior mitral leaflet plication); 2 patients underwent aortic valve replacement; 1 patient underwent aortic valve repair; 2 patients underwent aortic root replacement; 1 patient underwent Bentall’s procedure and 1 patient underwent coronary artery bypass grafting because of a breached muscle bridge. Results: One patient died of post-operative heart failure. The mean follow-up time was 4.3 years. There was significant improvement in the symptomatic status. Sixteen patients were asymptomatic with good effort tolerance and only four patients had New York heart association (NYHA) Classes I∼II due to associated valvular lesions. Conclusion: Our experience proved that symptomatic hypertrophic obstructive cardiomyopathy or non-symptomatic hypertrophic obstructive cardiomyopathy with combined heart disease is indication for surgery as surgical intervention could get better clinical results in this kind of patients compared with other non-surgical method because it beneficially reduces the systolic anterior motion (SAM) of the mitral valve leaflet, which could not be avoided by other non-surgical treatment.
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Chang, S.M., Nagueh, S.F., Spencer, W.H., Lakkis, N.M., 2003. Complete heart block: determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy. J. Am. Coll. Cardiol., 42(2):296–300. [doi:10.1016/S0735-1097(03)00623-5]
Cleland, W.P., 1963. The surgical management of obstructive cardiomyopathy. J. Cardiov. Surg., 4:489–491.
Cooley, D.A., 1991. Surgical techniques for hypertrophic left ventricular obstructive myopathy including mitral valve plication. J. Cardiac. Surg., 6:29–33.
Ferrari, R., Rydén, L., 2001. Hypertrophic cardiomyopathy: from molecular and genetic mechanisms to clinical management. European Heart Journal Supplements, 3(Suppl L):L1–L2. [doi:10.1016/S1520-765X(01)90056-2]
Ivens, E., 2004. Hypertrophic cardiomyopathy. Heart Lung and Circulation, 13(Suppl 3):S48–S55. [doi:10.1016/j.hlc.2004.09.021]
Marwick, T.H., Stewart, W.J., Lever, H.M., Lytle, B.W., Rosenkranz, E.R., Duffy, C.I., Salcedo, E.E., 1992. Benefits of intraoperative echocardiography in the surgical management of hypertrophic cardiomyopathy. J. Am. Coll. Cardiol., 20:1066–1072.
McIntosh, C.I., Maron, B.J., Cannon, R.O., Klues, H.G., 1992. Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Circulation, 86(Suppl 2):60–67.
Megevand, A., Ingles, J., Richmond, D.R., Semsarian, C., 2005. Long-term follow-up of patients with obstructive hypertrophic cardiomyopathy treated with dual-chamber pacing. Am. J. Cardiol., 95(8):991–993. [doi:10.1016/j.amjcard.2004.12.045]
Minakata, K., Dearani, J.A., Schaff, H.V., O’Leary, P.W., Ommen, S.R., Danielson, G.K., 2005. Mechanisms for recurrent left ventricular outflow tract obstruction after septal myectomy for obstructive hypertrophic cardiomyopathy. Ann. Thorac. Surg., 80(3): 851–856. [doi:10.1016/j.athoracsur.2005.03.108]
Morrow, A.G., Fogarty, T.J., Hannah, H., Braunwald, E., 1968. Operative treatment in idiopathic hypertrophic subaortic stenosis. Techniques and results of postoperative clinical and hemodynamic assessments. Circulation, 37:589–596.
Ommen, S.R., Maron, B.J., Olivotto, I., Maron, M.S., Cecchi, F., Betocchi, S., Gersh, B.J., Ackerman, M.J., McCully, R.B., Dearani, J.A., et al., 2005. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J. Am. Coll. Cardiol., 6(3):477–479.
Ralph-Edwards, A., Woo, A., McCrindle, B.W., Shapero, J.L., Schwartz, L., Rakowski, H., Wigle, E.D., Williams, W.G., 2005. Hypertrophic obstructive cardiomyopathy: comparison of outcomes after myectomy or alcohol ablation adjusted by propensity score. Journal of Thoracic and Cardiovascular Surgery, 129(2):351–358. [doi:10.1016/j.jtcvs.2004.08.047]
Roberts, R., Sigwart, U., 2005. Current concepts of the pathogenesis and treatment of hypertrophic cardiomyopathy. Circulation, 112(2):293–296. [doi:10.1161/01.CIR.0000146788.30724.0A]
Schoendube, F.A., Klues, H.G., Reith, S., Flachskampf, F.A., Hanrath, P., Messmer, B.J., 1995. Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation, 92:122–127.
Sigwart, U., 2001. Non-surgical myocardial reduction for patients with hypertrophic obstructive cardiomyopathy. European Heart Journal Supplements, 3(Suppl L):L38–L42. [doi:10.1016/S1520-765X(01)90063-X]
vanderLee, C., Kofflard, M.J., van Herwerden, L.A., Vletter, W.B., ten Cate, F.J., 2003. Sustained improvement after combined anterior mitral leaflet extension and myectomy in hypertrophic obstructive cardiomyopathy. Circulation, 108(17): 2088–2092. [doi:10.1161/01.CIR.0000092912.57140.14]
vanderLee, C., ten Cate, F.J., Geleijnse, M.L., Kofflard, M.J., Pedone, C., van Herwerden, L.A., Biagini, E., Vletter, W.B., Serruys, P.W., 2005. Percutaneous versus surgical treatment for patients with hypertrophic obstructive cardiomyopathy and enlarged anterior mitral valve leaflets. Circulation, 112(4):482–488. [doi:10.1161/CIRCULATIONAHA.104.508309]
Yacoub, M.H., 2005. Surgical versus alcohol septal ablation for hypertrophic obstructive cardiomyopathy: the pendulum swings. Circulation, 112(4):450–452. [doi:10.1161/CIRCULATIONAHA.105.553313]
Yoerger, D.M., Weyman, A.E., 2003. Hypertrophic obstructive cardiomyopathy: mechanism of obstruction and response to therapy. Rev. Cardiovasc. Med., 4(4):199–215.
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Zhu, Yb., Rajan, S., Kurian, V.M. et al. Surgical outcomes and strategy of hypertrophic obstructive cardiomyopathy. J. Zhejiang Univ. - Sci. B 7, 148–153 (2006). https://doi.org/10.1631/jzus.2006.B0148
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DOI: https://doi.org/10.1631/jzus.2006.B0148