Echocardiographic findings late after myectomy in hypertrophic obstructive cardiomyopathy

Abstract

Postoperative echocardiograms of 50 patients undergoing myectomy for hypertrophic obstructive cardiomyopathy between 1965 and 1982 have been evaluated. In 21 patients a comparison with preoperative echocardiograms showed that postoperatively there was a significant reduction of septal and free wall thickness, an increase of left ventricular end-diastolic as well as outflow tract dimensions and a reduction or disappearance of systolic anterior motion of the mitral leaflet. Postoperative examination at intervals greater than 3 years revealed a significant increase of left ventricular and left atrial cavity size with unchanged contractile parameters and little reduction of left ventricular hypertrophy. In 4 of 12 patients evaluated greater than 8 years after myectomy, left ventricular dilatation was observed and 3 of these 4 patients developed congestive heart failure. Development of left ventricular dilatation was independent of whether a transventricular and/or transaortic approach was used for myectomy. These data indicate that the late course after myectomy in hypertrophic obstructive cardiomyopathy may be complicated by dilatation of the left ventricular cavity.

Changes of the Degree of Hypertrophy in Hypertrophic Obstructive Cardiomyopathy under Medical and Surgical Treatment

“…This was not yet the case at the 16 early postoperative investiga tion dates apart from one exception, but was only to be observed during the further course. This decrease is consistent with the postoperative measurements of Turina et al [30]. A possible explanation is on the one hand that a structural dilatation had postoperatively led to the measurement of a lower wall thickness.…”

Hypertrophic Cardiomyopathy With Left Ventricular Systolic Dysfunction

“…Nonetheless, 2 smaller studies also identified an increased risk of developing impaired LV function after SRT 20 and emphasized that the duration of follow-up needs to be relatively long, at least 8 to 10 years, to capture this adverse remodeling. 21 This time frame is supported by our current findings. Similarly, all but 1 published study focusing on HCM-LVSD systematically excluded patients who underwent SRT.…”

Predictors of long‐term outcome after septal myectomy in symptomatic hypertrophic obstructive cardiomyopathy patients with previous alcohol septal ablation and residual obstruction

“…Thus, we speculated that a subgroup of HOCM patients with systolic dysfunction as well as normal or supernormal LVEF may exist, which would keep progressing to a dilated‐hypokinetic form of hypertrophic cardiomyopathy even after surgical septal myectomy . Turina et al first reported development of CHF associated with left ventricular dilatation at 8 years after surgical septal myectomy. In fact, previous studies found global strain in patients with HCM was significant reduced compared with healthy subjects despite normal left ventricular function as assessed by standard criteria such as LVEF or fraction shortening, suggesting the presence of a global subclinical systolic dysfunction .…”

“…Thus, we speculated that a subgroup of HOCM patients with systolic dysfunction as well as normal or supernormal LVEF may exist, which would keep progressing to a dilated-hypokinetic form of hypertrophic cardiomyopathy even after surgical septal myectomy. 22 Turina et al 23 first reported development of CHF associated with left ventricular dilatation at 8 years after surgical septal myectomy. In fact, previous studies found global strain in patients with HCM was significant reduced compared with healthy subjects despite normal left ventricular function as assessed by standard criteria such as LVEF or fraction shortening, suggesting the presence of a global subclinical systolic dysfunction.…”