Pathoanatomic Findings and Treatment During Hypertrophic Obstructive Cardiomyopathy Surgery: The Role of Mitral Valve

Raffa, Giuseppe Maria; Romano, Giuseppe; Turrisi, Marco; Morsolini, Marco; Gentile, Giovanni; Sciacca, Sergio; Armaro, Alessandro; Stringi, Vincenzo; Mattiucci, Gabriella; Magro, Serena; Cosentino, Fabiola; Clemenza, Francesco; Pilato, Michele

doi:10.1016/j.hlc.2018.02.006

Cited by 17 publications

(18 citation statements)

References 23 publications

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“…NYHA functional class significantly decreased from the preoperative value and the clinical symptom improved in both groups, with no patients being class III or IV and no significant difference between groups, suggesting that both myectomy with concomitant mitral subvalvular procedures and myectomy alone achieved similar clinical benefits. Our results were consistent with that in previous literatures [ 9 , 21 , 22 ].…”

Section: Discussionsupporting

confidence: 94%

Characteristics and Surgical Results of Patients with Hypertrophic Obstructive Cardiomyopathy without Intrinsic Mitral Valve Diseases Undergoing Mitral Subvalvular Procedures during Myectomy

Wang

Yang

et al. 2020

Cardiology Research and Practice

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Background. Mitral subvalvular procedures have acquired a major role during hypertrophic obstructive cardiomyopathy (HOCM) surgery. However, few studies have focused on characterizing the clinical feature of HOCM patients without intrinsic mitral valve (MV) diseases undergoing mitral subvalvular procedures in addition to myectomy. Additionally, scant data about the results of mitral subvalvular procedures during HOCM surgery are available. This single-center study aims to characterize the clinical feature and surgical results of HOCM patients without intrinsic MV diseases undergoing mitral subvalvular procedures in addition to myectomy in comparison with those receiving myectomy alone. Methods. Among 181 eligible patients, 50 (27.6%) patients undergoing myectomy plus mitral subvalvular procedures were entered into the combined group, and the remaining 131 patients receiving myectomy alone were included in the alone group. Baseline and surgical characteristics were investigated, and surgical results were compared. Results. Comparatively, the combined group was younger (52.9 ± 11.2 years vs. 56.8 ± 11.8 years, p = 0.045 ) and had a better New York Heart Association (NYHA) class ( p = 0.034 ) and less septal hypertrophy (16.4 ± 2.3 mm vs. 18.5 ± 3.2 mm, p < 0.001 ). Septal thickness was independently associated with combined procedures in multivariable logistic regression analysis (OR = 0.887, 95% CI 0.612–0.917). No surgical death or iatrogenic septal perforation occurred in the combined group. Two (6.5%) patients in the combined group developed complete atrioventricular block and required permanent pacemaker implantation. During a median follow-up of 10 months, no deaths or reoperations were observed with the symptom of relief and NYHA class I or II in either group. Patients in the combined group as compared to the alone group had lower outflow tract gradients and a lower incidence of residual systolic anterior motion (SAM) syndrome. Conclusions. For HOCM patients without intrinsic MV diseases who are scheduled for surgery, a less pronounced septal hypertrophy may be closely associated with myectomy with concomitant mitral subvalvular procedures instead of myectomy alone. Mitral subvalvular procedures during myectomy are safe and allow the reduction of outflow tract gradients and freedom from SAM more effectively in comparison with myectomy alone.

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Section: Discussionsupporting

confidence: 94%

Characteristics and Surgical Results of Patients with Hypertrophic Obstructive Cardiomyopathy without Intrinsic Mitral Valve Diseases Undergoing Mitral Subvalvular Procedures during Myectomy

Wang

Yang

et al. 2020

Cardiology Research and Practice

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“…It is mainly characterized by asymmetric left ventricular (LV) hypertrophy and LV outflow tract obstruction, accompanied by mitral valve insufficiency and LV diastolic and systolic dysfunction in various degree. Symptoms such as chest pain, chest tightness, dyspnea, and syncope would appear in mild HOCM cases, while heart failure or sudden death can occur in severe cases 2,3 . HOCM is the leading cause of sudden death among teenagers and athletes 2,3 .…”

Section: Introductionmentioning

confidence: 99%

“…Symptoms such as chest pain, chest tightness, dyspnea, and syncope would appear in mild HOCM cases, while heart failure or sudden death can occur in severe cases 2,3 . HOCM is the leading cause of sudden death among teenagers and athletes 2,3 . As to its treatment, ventricular septal volume reduction procedures, such as percutaneous transluminal septal myocardial ablation (gold standard), are the choices for HOCM patients who are refractory to medication.…”

Section: Introductionmentioning

confidence: 99%

Clinical value of 2D speckle tracking imaging in evaluating the effect of percutaneous intramyocardial septal radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy

Qian

Zhou

Liu

et al. 2021

J of Clinical Ultrasound

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Purpose To explore the short‐term changes after percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) in patients with hypertrophic obstructive cardiomyopathy (HOCM), using quantitative analysis of two‐dimensional speckle tracking imaging (2D‐STI). Methods This prospective self‐controlled study included 30 HOCM patients treated with PIMSRA. The study for each patient spanned over at least 1 year. Interventricular septal thickness and the left ventricular outflow tract peak pressure gradient (LVOT‐PG) were measured through echocardiography, and 2D‐STI was used to evaluate the left ventricular (LV) systolic function and synchrony. Cardiac function was assessed using the New York Heart Association's (NYHA) functional classification for cardiac disease, and through the serum levels of cardiac troponin I (cTnI) and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). Biomarkers procollagen type I carboxy‐terminal propeptide (PICP) and matrix metalloproteinases‐2 (MMP‐2) were detected for noninvasive assessment of myocardial fibrosis. Results The patients' interventricular septal thickness, LVOT‐PG, NYHA class, and plasma PICP and MMP‐2 levels at the first month postoperatively were significantly lower than before operation (all P < .05). The 2D‐STI quantitative variables of LV systolic function and synchrony improved significantly (all P < .05). They improved further 1 year postoperatively (P < .01 or P < .001). Serum cTnI and NT‐proBNP levels increased 1 month postoperatively, but significantly decreased 1 year postoperatively (both P < .05). Pearson or Spearman correlation analysis showed that the improvement of interventricular septal thickness, LVOT‐PG, NYHA class, and the levels of cTnI, NT‐proBNP, PICP and MMP‐2, were in positive correlation with the restoration of LV systolic function and synchrony (P < .01 or P < .001). Conclusion The changes in 2D‐STI quantitative variables related to LV systolic function and synchrony are closely correlated with the improvement of cardiac function in HOCM patients after PIMSRA. These 2D‐STI variables can serve for objective, accurate, and noninvasive evaluation of the HOCM treatment.

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“…Several malformations can affect the mitral valve in patients with HOCM [2] and it is almost a constant to observe abnormal chordae and papillary muscles (PM) that deserve some consideration during HOCM surgery. We introduced the concept of "subvalvular mitral apparatus remodeling" [3] aimed at freeing the posterior motion of the anterior mitral leaflet away from the septum, moving back the coaptation plane of the mitral valve, in order to abolish the SAM and LVOT obstruction. We reviewed the charts of 43 consecutive patients (age, 56 AE 11 years; 25 women) who undewent HOCM surgery since 2007.…”

Section: Hypertrophic Obstructive Cardiomyopathy and Subvalvular Mitral Apparatus Remodelingmentioning

confidence: 99%

Hypertrophic Obstructive Cardiomyopathy and Subvalvular Mitral Apparatus Remodeling

Raffa

Pilato

2019

The Annals of Thoracic Surgery

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Pathoanatomic Findings and Treatment During Hypertrophic Obstructive Cardiomyopathy Surgery: The Role of Mitral Valve

Cited by 17 publications

References 23 publications

Characteristics and Surgical Results of Patients with Hypertrophic Obstructive Cardiomyopathy without Intrinsic Mitral Valve Diseases Undergoing Mitral Subvalvular Procedures during Myectomy

Characteristics and Surgical Results of Patients with Hypertrophic Obstructive Cardiomyopathy without Intrinsic Mitral Valve Diseases Undergoing Mitral Subvalvular Procedures during Myectomy

Clinical value of 2D speckle tracking imaging in evaluating the effect of percutaneous intramyocardial septal radiofrequency ablation in patients with hypertrophic obstructive cardiomyopathy

Hypertrophic Obstructive Cardiomyopathy and Subvalvular Mitral Apparatus Remodeling

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