Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Molisana, Michela; Selimi, Adelina; Gizzi, Germana; D’Agostino, Simone; Ianni, Umberto; Parato, Vito Maurizio

doi:10.3389/fcvm.2022.1020054

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…It has been associated with effective outcomes with minimal complications. Furthermore, MVR surgery has also been implemented for these patients to correct MV malformations caused by this disorder 21 and reduce LVOT gradient, resulting in decent symptom relief and acceptable complications. 22 , 23 The treatment team should carefully select the type of surgical treatment for each HCM patient, considering the patient's unique characteristics.…”

Section: Discussionmentioning

confidence: 99%

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Ayati,

Khoshfetrat,

Davoodi

et al. 2024

Health Science Reports

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BackgroundHypertrophic cardiomyopathy (HCM) affects millions of individuals worldwide. In severe cases, it can cause life‐threatening conditions such as left ventricular outflow tract (LVOT) obstruction, mitral regurgitation (MR), and sudden cardiac death, making surgical treatment necessary. This study aimed to report the long‐term outcomes of HCM patients undergoing septal myectomy or mitral valve replacement (MVR) and compare the results between different types of surgeries.MethodsThis was a retrospective cohort study on HCM patients who underwent surgical treatment in an Iranian referral center between 2005 and 2021. Patients were divided into three groups according to the type of surgery received: septal myectomy, MVR, or a combination of both surgeries. Patient characteristics, surgical and echocardiographic features, and in‐hospital and long‐term outcomes were reported and compared between the three groups.ResultsA total of 102 patients with an average age of 53.3 ± 16.9 were included. Twenty‐six patients had septal myectomy, 23 had MVR, and 53 had combined septal myectomy and MVR surgery. All surgeries were associated with a significant reduction in interventricular septum thickness and LVOT gradients. After a median of 6.8‐year follow‐up time, patients with an isolated septal myectomy had significantly lower mortality and major adverse cardiac and cerebrovascular events rates than the other groups.ConclusionIsolated septal myectomy showed better long‐term survival rates and can correct HCM‐related MR, while MVR should be preserved only for intrinsic valve defects. More extensive studies are needed to confirm these findings and achieve a comprehensive guideline on surgical treatment of HCM.

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Section: Discussionmentioning

confidence: 99%

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Ayati,

Khoshfetrat,

Davoodi

et al. 2024

Health Science Reports

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“…In patients with obstructive HCM, the mitral leaflet can be retracted by the abnormally fibrotic secondary chordae, and chordal resection can let the tethered leaflet fall posteriorly and away from the septum [ 6 , 46 ] (Fig. 3 ).…”

Section: Procedures On the Mitral Chordaementioning

confidence: 99%

Mitral Valve in Obstructive Hypertrophic Cardiomyopathy: Abnormalities, Management and Controversies

Wu,

Xie,

et al. 2023

Rev. Cardiovasc. Med.

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Obstructive hypertrophic cardiomyopathy (obstructive HCM) is a hereditary disease characterized by septal hypertrophy and dynamic left ventricular outflow tract (LVOT) obstruction. Other than septal hypertrophy, mitral valve abnormalities are also quite common in patients with obstructive HCM, which may contribute to systolic anterior motion (SAM) of the mitral valve and LVOT obstruction. Surgical myectomy is the standard treatment to achieve anatomic correction of obstructive HCM, but controversies remain on whether and how the mitral valve procedures should be performed at the same time. In this review, we first described the mitral valve abnormalities in patients with obstructive HCM and their surgical corrections, we then explained the controversies based on current clinical studies, and we finally made a brief introduction on our surgical strategy and results.

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Section: Introductionmentioning

confidence: 99%

“…Studies examining the mitral valve in patients with HCM have shown that the mitral valve itself can be structurally altered [8,9]. Therefore, a detailed evaluation of the anatomy and function of the mitral valve, as well as the significance of mitral regurgitation (MR), is essential in patients with HCM [8][9][10][11]. The aim of our study is to examine the potential influence of moderate or moderately severe MR on the prognosis, clinical presentation, and structural characteristics of HCM patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Mitral Regurgitation in Patients with Primary Hypertrophic Cardiomyopathy

Tesic,

Travica,

Giga

et al. 2023

Medicina

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Background and Objectives: Mitral valve pathology and mitral regurgitation (MR) are very common in patients with hypertrophic cardiomyopathy (HCM), and the evaluation of mitral valve anatomy and degree of MR is important in patients with HCM. The aim of our study was to examine the potential influence of moderate or moderately severe MR on the prognosis, clinical presentation, and structural characteristics of HCM patients. Materials and Methods: A prospective study examined 176 patients diagnosed with primary asymmetric HCM. According to the severity of the MR, the patients were divided into two groups: Group 1 (n = 116) with no/trace or mild MR and Group 2 (n = 60) with moderate or moderately severe MR. All patients had clinical and echocardiographic examinations, as well as a 24 h Holter ECG. Results: Group 2 had significantly more often the presence of the obstructive type of HCM (p < 0.001), syncope (p = 0.030), NYHA II class (p < 0.001), and atrial fibrillation (p = 0.023). Also, Group 2 had an enlarged left atrial dimension (p < 0.001), left atrial volume index (p < 0.001), and indirectly measured systolic pressure in the right ventricle (p < 0.001). Patients with a higher grade of MR had a significantly higher E/e′ (p < 0.001) and, as a result, higher values of Nt pro BNP values (p < 0.001) compared to Group 1. Kaplan–Meier analysis demonstrated that the event-free survival rate during a median follow-up of 88 (IQR 40–112) months was significantly higher in Group 1 compared to Group 2 (84% vs. 45% at 8 years; log-rank 20.4, p < 0.001). After adjustment for relevant confounders, the presence of moderate or moderately severe MR remained as an independent predictor of adverse outcomes (HR 2.788; 95% CI 1.221–6.364, p = 0.015). Conclusions: The presence of moderate or moderately severe MR was associated with unfavorable long-term outcomes in HCM patients.

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Different mechanisms of mitral regurgitation in hypertrophic cardiomyopathy: A clinical case and literature review

Cited by 5 publications

References 30 publications

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Comparing long‐term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran

Mitral Valve in Obstructive Hypertrophic Cardiomyopathy: Abnormalities, Management and Controversies

Prognostic Value of Mitral Regurgitation in Patients with Primary Hypertrophic Cardiomyopathy

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