Surgical treatment versus medical treatment in hypertrophic obstructive cardiomyopathy

Rothlin, M; Gobet, D.; Haberer, Thomas; Krayenbuehl, H. P.; Turina, Marko; Senning, Å

doi:10.1093/eurheartj/4.suppl_f.215

Cited by 31 publications

(6 citation statements)

References 16 publications

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“…The efficacy of operations for 'relief of obstruction' has been questioned on the basis of high operative mortality and failure to reduce the incidence of sudden death (Canedo & Frank, 1981;Nishimura et al, 1983). However, several groups have continued to recommend septal myectomy as a treatment of choice for symptomatic patients with high pressure gradients (Maron et al, 1983;Rothlin et al, 1983). Because the operation usually abolishes the pressure gradient and concurrently improves the symptomatic status of the patient at least one functional class, the results of the operation have been used as further proof that 'obstruction' is of primary significance.…”

Section: The Third Decadementioning

confidence: 99%

Obstruction is unimportant in the pathophysiology of hypertrophic cardiomyopathy

Criley¹,

Siegel²

1986

Postgraduate Medical Journal

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Summary:There has been a longstanding controversy about the significance of intracavitary pressure gradients in hypertrophic cardiomyopathy (HCM). It has been generally assumed that the gradient is the result of an 'obstruction' that impedes left ventricular outflow and which can be relieved by operative intervention. In the first decade after the discovery of HCM , the site of 'obstruction' was thought to be a muscular sphincter or contraction ring in the submitral region of the left ventricle, and operations designed to emulate pyloromyectomy (for hypertrophic pyloric stenosis) were developed. Following a challenge to the existence of the 'contraction ring' and an alternative non-obstructive explanation of the pressure gradient, the site of 'obstruction' was translocated to a point of apposition between the anterior mitral leaflet and the interventricular septum, a result of systolic anterior motion (SAM) of the mitral valve. Despite the translocation of the site and mechanism of 'obstruction', the operation for 'relief of obstruction' has not changed significantly. The newer site of 'obstruction' has been challenged on the grounds that the ventricle is not demonstrably impeded in its emptying; when a gradient is provoked, the ventricle empties more rapidly and more completely than it does without a gradient. In addition to a non-obstructive explanation of the gradient, other phenomena thought to be indicative of 'obstruction' can be explained by rapid and complete emptying of the ventricle (cavitary obliteration). Since the morbidity and mortality of symptomatic HCM patients without pressure gradients may exceed that of patients with pressure gradients, it is suggested that 'obstruction' may be unimportant in the pathophysiology of HCM and attention should be focused on abnormal diastolic function and life threatening arrhythmias.

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Section: The Third Decadementioning

confidence: 99%

Obstruction is unimportant in the pathophysiology of hypertrophic cardiomyopathy

Criley¹,

Siegel²

1986

Postgraduate Medical Journal

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“…In the experience of our clinic 10 year survival rate in surgical patients was not significantly higher than in nonsurgical ones (80% vs. 71%) but patients were not assigned at random to surgical or medical treatment and therefore were not truly comparable. In fact patients with high resting gradients were selected for myectomyf 5 '. Because of many differences between patient characteristics in surgical and non-surgical cohorts any comparison remains speculative.…”

Section: Surgical Treatment Of Hypertrophic Obstructive Cardiomyopathymentioning

confidence: 99%

Echocardiographic findings late after myectomy in hypertrophic obstructive cardiomyopathy

Turina¹,

Jenni²,

Krayenbuehl³

et al. 1986

European Heart Journal

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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.

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“…These show favorable hemodynamic effects [10][11][12][13][14][15][16][17], at least for a certain time. In highly symptom atic patients, the surgical intervention fre quently leads to good hemodynamic results [18][19][20][21][22], The question to be investigated in the present study was the extent to which the process of hypertrophy itself is influenced by different forms of therapy, i.e., whether it is feasible to attain regression of hypertrophy.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 1989

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The aim of our study was to establish the extent to which therapy of hypertrophic obstructive cardiomyopathy (HOCM) can influence the degree of hypertrophy. By means of two-dimensionally guided M-mode echocardiography, 120 patients with HOCM (age range 4–72 years, mean age 41 years) were observed over an average period of 49 ± 41 months. Depending on the respective therapy, we formed four patient groups: group 1:13 patients without any therapy (follow-up period 31 ± 30 months); group 2: 27 patients receiving propranolol (follow-up period 47 ± 34 months); group 3: 50 patients receiving verapamil (follow-up period 39 ± 27 months), and group 4: 30 patients with myectomy (follow-up period 34 ± 32 months). In group 4, as expected, the thickness of the interventricular septum (IVS) decreased postoperatively (from 24.2 ± 4.5 to 19.8 ± 6.7 mm, p < 0.05), and the left ventricular posterior wall (LVPW) thickness also decreased later postoperatively (from 13.0 ± 2.6 to 11.9 ± 2.3 mm, p < 0.05). The left ventricular diameters increased. In groups 2 and 3 treated with pharmacotherapy as in the untreated patients of group 1 on average there was no change in IVS and LVPW thickness nor in the left ventricular diameters (with the exception of increasing left ventricular end-diastolic diameter in the propranolol-treated group). In contrast to group 1 in occasional cases there were substantial decreases of IVS thickness (11% of the patients in group 2, 13 % in group 3) or LVPW thickness (13% of the patients in group 2, 12% in group 3). However, the thickness remained mainly unchanged (IVS: 74% of the patients in group 2, 71% in group 3; LVPW: 67% in group 2, 70% in group 3) or increased (IVS: 15% in group 2, 17% in group 3; LVPW: 21 % in group 2, 19% in group 3). The differences between groups 2 and 3 were not significant. Thus, our investigations indicated that on average neither propranolol nor verapamil leads to a regression of hypertrophy in HOCM.

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Surgical treatment versus medical treatment in hypertrophic obstructive cardiomyopathy

Cited by 31 publications

References 16 publications

Obstruction is unimportant in the pathophysiology of hypertrophic cardiomyopathy

Obstruction is unimportant in the pathophysiology of hypertrophic cardiomyopathy

Echocardiographic findings late after myectomy in hypertrophic obstructive cardiomyopathy

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

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