The development of segmental or generalized left ventricular hypokinesia is an unusual occurrence in patients with hypertrophic cardiomyopathy. To determine the incidence and possible pathophysiologic mechanisms responsible for this process, the serial clinical and laboratory data of 62 patients with the diagnosis of hypertrophic cardiomyopathy were analyzed. During a mean follow-up period of 8 years (range 2 to 21), 5 patients (Group A) developed left ventricular hypokinesia, whereas the remaining 57 patients (Group B) continued to exhibit the clinical and laboratory findings of hypertrophic cardiomyopathy. Three patients developed a dilated left ventricle with generalized hypokinesia; two other patients had segmental left ventricular wall motion abnormalities. None of these five patients who developed left ventricular hypokinesia had fixed coronary artery disease. The mean age, sex, mean duration of follow-up, presence of coronary myocardial bridges and angina pectoris, and an interventricular gradient were all similar in Groups A and B. Midventricular obliteration was seen in 4 (80%) of the 5 patients in Group A and in 4 (7%) of the 57 patients in Group B (p less than 0.001). Findings from this study reveal that segmental or generalized left ventricular hypokinesia can develop in patients with hypertrophic cardiomyopathy in the absence of fixed coronary artery disease. Such hypokinesia can occur after an acute myocardial infarction or it can develop gradually without clinical or electrocardiographic evidence of infarction. Patients with the mid-ventricular obliteration variant of hypertrophic cardiomyopathy are at a higher risk of developing segmental or diffuse left ventricular hypokinesia.

Risk factors were identified for early and late mortality in patients undergoing AVR after previous CABG. Although early morbidity and mortality were high, the longterm outcome of the survivors was favorable.

The long-term results of septal myotomy-myomectomy or mitral valve replacement, or both, were assessed in 36 patients with idiopathic hypertrophic subaortic stenosis who were followed up for 5 to 67 months (mean 48) postoperatively. The mean left ventricular outflow tract gradient at rest decreased postoperatively in all three patient groups. It decreased from 60 mm Hg (range 17 to 160) preoperatively to 3 mm Hg (range 0 to 20) postoperatively (p less than 0.001) in the 13 patients who underwent mitral valve replacement alone, from 69 mm Hg (range 18 to 140) to 35 mm Hg (range 20 to 50) (p less than 0.05) in the 12 patients who underwent myotomy-myomectomy alone and from 89 mm Hg (range 60 to 165) to 3.8 mm Hg (range 0 to 27) (p less than 0.001) in the 11 patients who underwent myomectomy plus mitral valve replacement. The reduction in gradient was more impressive after mitral valve replacement with or without septal myotomy-myomectomy than after septal myotomy-myomectomy alone. There was a marked reduction in symptoms after all three surgical procedures that was long-lasting and independent of the type of operation performed. There was no operative mortality. Postoperative annual mortality rate was 1.6%. Patients with severe congestive heart failure, significantly elevated left ventricular end-diastolic pressure and atrial fibrillation have a less favorable long-term postoperative prognosis. Septal myotomy-myomectomy is recommended as the procedure of choice for the majority of patients with idiopathic hypertrophic subaortic stenosis who require surgery, because it can alleviate symptoms without subjecting patients to the complications of a valve prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract