Significance of Papillary Muscle Abnormalities Identified by Cardiovascular Magnetic Resonance in Hypertrophic Cardiomyopathy

Harrigan, Caitlin; Appelbaum, Evan; Maron, Barry J.; Buros, Jacqueline L.; Gibson, C. Michael; Lesser, John R.; Udelson, James E.; Manning, Warren J.; Maron, Martin S.

doi:10.1016/j.amjcard.2007.10.032

Cited by 132 publications

(109 citation statements)

References 23 publications

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“…235,236 The opportunity for contrast-enhanced CMR with LGE to identify areas of myocardial fibrosis in patients with HCM has been the subject of a growing literature. 79 -81,237,238 Although patients with the end-stage phenotype almost universally demonstrate such findings, 49 patients with HCM with preserved systolic function may also have areas of LGE.…”

Section: Cardiovascular Magnetic Resonancementioning

confidence: 99%

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary

et al. 2011

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Section: Cardiovascular Magnetic Resonancementioning

confidence: 99%

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary

et al. 2011

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“…32 Compared with normal controls, studies using 3D CMR have demonstrated a higher frequency of papillary muscle abnormalities (anteroapical displacement and hypermobile bifid papillary muscles) in patients with HCM. 33,34 These patients have a high prevalence of SAM and elevated LV outflow tract (LVOT) gradients independent of septal thickness. There is increasing recognition that a subset of patients with dynamic LVOT obstruction (LVOTO) have normal thickness or minimal LVH, and the only abnormality noted involves abnormal orientation and hypermobility of papillary muscles (online-only Data Supplement Movie 2).…”

Section: Evaluation Of Mitral Valve and Subvalvular Apparatusmentioning

confidence: 99%

Imaging Phenotype Versus Genotype in Hypertrophic Cardiomyopathy

Desai

Ommen

McKenna

et al. 2011

Circ: Cardiovascular Imaging

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H ypertrophic cardiomyopathy (HCM) is a common monogenetic cardiac disease with a prevalence of 0.2% 1 that usually is inherited as an autosomal dominant trait with variable penetrance and expression. Clinically, HCM is defined by the presence of left ventricular (LV) hypertrophy (LVH) unexplained by abnormal loading conditions. 1 The natural history varies from an asymptomatic course to drugrefractory angina/dyspnea, sudden cardiac death (SCD), and end-stage heart failure. The incidence of HCM-related SCD is approximately 1% to 2% in children and adolescents and 0.5% to 1% in adults. 2,3 In this review, we examine the impact of advanced diagnostic imaging technologies on HCM, with particular emphasis on the detection of particular genetic subtypes.

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“…Recent use of three-dimensional echocardiography and magnetic resonance imaging (MRI) has identified HOCM patients with subtle findings of elongated mitral valves and displaced papillary muscles (12)(13)(14)(15)(16)(17); however, guidelines as to when to intervene on the mitral-subvalvular apparatus in conjunction with LVOT obstruction in the setting of HOCM remains unclear and largely dictated by individual center practices. Some centres advocate performing additional mitral procedures in patients with a basal septum less than 1.8 cm (4).…”

Section: Discussionmentioning

confidence: 99%

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

Vanderlaan

Woo

Ralph-Edwards

2017

Ann. Cardiothorac. Surg.

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Background: Isolated septal myectomy is considered the gold standard for refractory left ventricular outflow tract (LVOT) obstruction at centers with dedicated hypertrophic obstructive cardiomyopathy (HOCM) surgeons. In this paper, we provide an update on the Toronto General Hospital (TGH) experience for isolated septal myectomy and comment on the safety and efficacy of myectomy in patients with thin basal septal thickness at our institution. Methods:We retrospectively reviewed all patients undergoing surgical myectomy at our institution from January 2012 to August 2016. We analyzed patient characteristics, intraoperative variables, pre-and postprocedural echocardiographic parameters, and key outcomes including post-operative stroke, renal failure, iatrogenic ventricular septal defect (VSD), post-procedure insertion of permanent pacemaker, and mortality.Results: At our institution, 150 isolated septal myectomy surgeries were performed over the study period.Preoperative echocardiography demonstrated an average basal septal thickness of 2.10±0.43 cm with a resting gradient of 67±37 mmHg and a provoked gradient of 89±40 mmHg. Fifty percent of patients had significant systolic anterior motion (SAM) of their mitral valve and 53% had associated moderate to severe mitral regurgitation (MR). Of note, 24% of patients had a thin septum of ≤1.7 cm. Discharge echocardiograms demonstrated significant septal reduction to an average basal septal thickness of 1.04±0.26 (P<0.05), with negligible resting and provokable LVOT gradients. At the time of discharge, none of the patients had significant SAM and only 5.3% of patients had residual greater than mild MR. Patients undergoing isolated myectomy with a thin basal septum had similar outcomes to those with a >1.7 cm septal thickness. In our contemporary cohort, there were no iatrogenic VSDs, 5.3% of patients required a permanent pacemaker and there was one early death.Conclusions: Our cohort demonstrates that isolated septal myectomy remains a safe and effective operation that can achieve excellent results, irrespective of basal septal thickness, when done by experienced surgeons in a dedicated hypertrophic cardiomyopathy (HCM) center.

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Significance of Papillary Muscle Abnormalities Identified by Cardiovascular Magnetic Resonance in Hypertrophic Cardiomyopathy

Cited by 132 publications

References 23 publications

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary

2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy: Executive Summary

Imaging Phenotype Versus Genotype in Hypertrophic Cardiomyopathy

Isolated septal myectomy for hypertrophic obstructive cardiomyopathy: an update on the Toronto General Hospital experience

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