Long-term Clinical and Echocardiographic Follow-up After Surgical Correction of Hypertrophic Obstructive Cardiomyopathy With Extended Myectomy and Reconstruction of the Subvalvular Mitral Apparatus

Schoendube, Friedrich A.; Klues, Heinrich G.; Reith, Sebastian; Flachskampf, Frank A.; Hanrath, Peter; Messmer, Bruno J.

doi:10.1161/01.cir.92.9.122

Cited by 171 publications

(115 citation statements)

References 35 publications

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“…[23][24][25] Our findings showed a high incidence of complete heart block (nearly 50 percent) that occurred during the procedure and eventually required placement of a permanent pacemaker in a quarter of all patients. Reports from other centers show a similar rate.…”

Section: Discussionmentioning

confidence: 68%

Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

et al. 2002

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Section: Discussionmentioning

confidence: 68%

Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

et al. 2002

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“…The reduced cross sectional area of the LVOT is not the only determinant of LVOTO, and multiple interrelated factors, such as heterogeneity of the hypertrophied septum, structural abnormality of the MV, and anatomical variants of the PM also interact in the pathophysiology. [6][7][8][9][10]16,17) An optimal surgical outcome with sufficient relief of both LVOTO and MR requires the following factors to be addressed, 16) and thus the Morrow procedure has been modified and additional procedures have been proposed for this purpose. First, extended myectomy (about a 7cm resection) has been recommended, in which the septal bulge is more extensively resected than in the classical Morrow procedure (about a 3cm resection) to the base of the PMs.…”

Section: Discussionmentioning

confidence: 99%

“…First, extended myectomy (about a 7cm resection) has been recommended, in which the septal bulge is more extensively resected than in the classical Morrow procedure (about a 3cm resection) to the base of the PMs. [8][9][10]12,16,17) This can relieve SAM more effectively by pushing the AML more posteriorly and redirecting the blood flow within the LV away from the MV. This approach can also prevent midventricular obstruction, which may cause recurrent LVOTO, even after successful relief of SAM.…”

Section: Discussionmentioning

confidence: 99%

A Surgical Experience of Symptomatic Sigmoid Septum: Drastic Exacerbation of Mitral Regurgitation after Sufficient Ventricular Septal Myectomy

Fujita¹,

Nakashima²,

Kumakura³

et al. 2014

ATCS

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A 74-year-old woman presented with progressive dyspnea on exertion. Transthoracic echocardiography (TTE) demonstrated significant left ventricular outflow tract (LVOT) obstruction with a pressure gradient of 100 mmHg caused by a sigmoid septum (SS). Mitral regurgitation (MR) of a mild to moderate degree occurred due to systolic anterior motion (SAM) of the anterior mitral leaflet (AML), with no intrinsic mitral valve (MV) abnormality. Myectomy of the hypertrophied septal bulge ameliorated the pressure gradient to 8 mmHg with similar MR. However, just before the sternal closure, hemodynamic status deteriorated drastically to ventricular fibrillation. MR exacerbated to a severe degree with an uncertain etiology; thus, a mechanical prosthetic valve was implanted. The postoperative course was complicated by prolonged mechanical ventilation due to massive pulmonary edema and complete atrioventricular block (CAVB) requiring permanent pacemaker implantation. One year postoperatively, the patient is asymptomatic and TTE revealed no residual pressure gradient with an iatrogenic ventricular septal defect (VSD). This case, the first published surgical experience of SS, may indicate that secondary MR, which is usually relieved by sufficient myectomy in hypertrophic cardiomyopathy (HCM), can exacerbate markedly, and that myectomy might not be advisable in SS. The therapeutic strategy must be considered carefully before embarking on surgical intervention.

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“…3 Surgical myectomy can reduce the LVOT gradient markedly and improve symptoms, but has a high risk of mortality. 4 Although we initially intended to implant a DDD pacemaker for the present case, the patient rejected any surgical treatment and so we selected PTSMA.…”

Section: Discussionmentioning

confidence: 99%

“…4 Knight et al 5 and Seggewiss et al 6 have both reported that PTSMA significantly reduces LVOT obstruction and improves the symptoms in HOCM, but it has also been reported that permanent pacemaker implantation was required in 20% of the patients because of complete atrioventricular block associated with this procedure. Faber et al 7 reported that myocardial contrast echocardiography (MCE) for target vessel selection in PTSMA improved both the acute and chronic results.…”

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confidence: 99%

Usefulness of Selective Myocardial Contrast Echocardiography in Percutaneous Transluminal Septal Myocardial Ablation. A Case Report.

et al. 2001

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ercutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM) to reduce left ventricular outflow tract (LVOT) obstruction was first reported by Sigwart in 1995 1 as an alternative treatment to medical therapy, 2 dual chamber pacing 3 and surgical myectomy. 4 Knight et al 5 and Seggewiss et al 6 have both reported that PTSMA significantly reduces LVOT obstruction and improves the symptoms in HOCM, but it has also been reported that permanent pacemaker implantation was required in 20% of the patients because of complete atrioventricular block associated with this procedure. Faber et al 7 reported that myocardial contrast echocardiography (MCE) for target vessel selection in PTSMA improved both the acute and chronic results. We describe a case of HOCM treated by PTSMA in which intraprocedural selective MCE was very helpful in identifying the culprit septal branch. Case ReportA 67-year-old woman visited the outpatient clinic complaining of dyspnea and chest discomfort on exertion. She had a family history of hypertrophic cardiomyopathy in her son, who died suddenly 1 year ago. She had a 4/6 ejection murmur at the left third interspace and the chest X-ray showed a slightly enlarged left ventricle. The ECG confirmed left ventricular hypertrophy with strain and the echocardiogram showed asymmetrical septal hypertrophy with systolic anterior movement of the mitral valve and grade II mitral regurgitation. The left ventricular outflow tract (LVOT) gradient was approximately 150 mmHg by Doppler echocardiography. Thus, she was diagnosed as having HOCM. Her New York Heart Association (NYHA) functional class was III. Medical therapy with metoprolol (120 mg/day), diltiazem (90 mg/day) and disopyramide (300 mg/day) was started, and the LVOT gradient was reduced to approximately 100 mmHg. However, her symptoms were refractory to medical therapy and the NYHA functional A 67-year-old woman with hypertrophic obstructive cardiomyopathy that was refractory to medical treatment underwent percutaneous transluminal septal myocardial ablation (PTSMA). The septal branch supplying the myocardium involved in the left ventricular outflow tract (LVOT) obstruction was identified by selective myocardial contrast echocardiography (MCE). MCE for the third and largest septal branch opacified the right side of the mid-septal myocardium and MCE for the second septal branch opacified the right side of the basal portion of the septal myocardium. Finally, contrast agent was injected into the first, small branch, which opacificied the myocardium protruding into the LVOT. Subsequently, septal myocardial ablation for this vessel with intracoronary alcohol was performed, followed by a reduction of the LVOT gradient and successful, dramatic improvement in the patient's clinical condition. Selective MCE was very useful to identify the appropriate septal branch for PTSMA and enabled maximal effect of this treatment with minimal myocardial damage. (

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Long-term Clinical and Echocardiographic Follow-up After Surgical Correction of Hypertrophic Obstructive Cardiomyopathy With Extended Myectomy and Reconstruction of the Subvalvular Mitral Apparatus

Cited by 171 publications

References 35 publications

Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

Nonsurgical Reduction of the Interventricular Septum in Patients with Hypertrophic Cardiomyopathy

A Surgical Experience of Symptomatic Sigmoid Septum: Drastic Exacerbation of Mitral Regurgitation after Sufficient Ventricular Septal Myectomy

Usefulness of Selective Myocardial Contrast Echocardiography in Percutaneous Transluminal Septal Myocardial Ablation. A Case Report.

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