Echocardiography before and after Resect-Plicate-Release Surgical Myectomy for Obstructive Hypertrophic Cardiomyopathy

Halpern, Dan; Swistel, Daniel G.; Po, Jose Ricardo; Joshi, Rajeev; Winson, Glenda; Arabadjian, Milla; Lopresto, Charles; Kushner, Josef; Kim, Bette; Balaram, Sandhya K.; Sherrid, Mark V.

doi:10.1016/j.echo.2015.07.002

Cited by 53 publications

(43 citation statements)

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“…[15][16][17][18][19][20]24,26 Thus, mitral-septal contact was shown by provocation to be inherent to their HCM with latent obstruction, For our 13 patients, high provocable gradients due to SAM, and the morphologic predispositions to SAM of HCM were present temporally remote from the ballooning episode, at a time when the LV systolic function was normal.…”

Section: Variation In Gradient During the Ballooning Admissionmentioning

confidence: 62%

“…Detailed measurements were made from echocardiograms, during the ballooning episode, and before or after the episode, at a time when LV function was normal. [23][24][25] Papillary muscle and chordal abnormalities position the mitral valve anteriorly in the LV cavity, subjecting it to the drag of ejection flow. We measured segmental LV wall thicknesses from 2D echocardiography as previously reported.…”

Section: Echocardiographymentioning

confidence: 99%

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Hypertrophic cardiomyopathy with dynamic obstruction and high left ventricular outflow gradients associated with paradoxical apical ballooning

et al. 2018

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Background: Acute left ventricular (LV) apical ballooning with normal coronary angiography occurs rarely in obstructive hypertrophic cardiomyopathy (OHCM); it may be associated with severe hemodynamic instability. Methods, Results:We searched for acute LV ballooning with apical hypokinesia/akinesia in databases of two HCM treatment programs. Diagnosis of OHCM was made by conventional criteria of LV hypertrophy in the absence of a clinical cause for hypertrophy and mitral-septal contact. Among 1519 patients, we observed acute LV ballooning in 13 (0.9%), associated with dynamic left ventricular outflow tract (LVOT) obstruction and high gradients, 92 ± 37 mm Hg, 10 female (77%), age 64 ± 7 years, LVEF 31.6 ± 10%. Septal hypertrophy was mild compared to that of the rest of our HCM cohort, 15 vs 20 mm (P < 0.00001). An elongated anterior mitral leaflet or anteriorly displaced papillary muscles occurred in 77%. Course was complicated by cardiogenic shock and heart failure in 5, and refractory heart failure in 1. High-dose beta-blockade was the mainstay of therapy. Three patients required urgent surgical relief of LVOT obstruction, 2 for refractory cardiogenic shock, and one for refractory heart failure. In the three patients, surgery immediately normalized refractory severe LV dysfunction, and immediately reversed cardiogenic shock and heart failure. All have normal LV systolic function at 45-month follow-up, and all have survived.Conclusions: Acute LV apical ballooning, associated with high dynamic LVOT gradients, may punctuate the course of obstructive HCM. The syndrome is important to recognize on echocardiography because it may be associated with profound reversible LV decompensation. K E Y W O R D S hypertrophic cardiomyopathy, left ventricular outflow obstruction, left ventricular systolic dysfunction

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Section: Variation In Gradient During the Ballooning Admissionmentioning

confidence: 62%

Section: Echocardiographymentioning

confidence: 99%

Hypertrophic cardiomyopathy with dynamic obstruction and high left ventricular outflow gradients associated with paradoxical apical ballooning

et al. 2018

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“…However, the agreement between echocardiography‐ and CMR‐measured lengths is suboptimal (Figure ), and so the non‐interchangeability between techniques represents a drawback we should be aware of when standardizing measurement approach at each center. At this point, it is worth noting that the alternate way to measure anterior MVL length, that is from the anterior MVL tip to the aortic annulus at the insertion point of the noncoronary aortic leaflet, shows similar differences between HCM patients and controls (Table ) with slightly improved inter‐technique agreement and reproducibility (Data : Bland–Altman graph and reproducibility analysis). Therefore, it is reasonable to assume the two ways to measure the anterior leaflet length: method 1, from mitral hinge point to leaflet tip and method 2, from noncoronary aortic cusp insertion to leaflet tip.…”

Section: Discussionmentioning

confidence: 99%

“…This particularly involved the anterior leaflet, with mean values of 25 mm by the method of up to the mitral annulus hinge point 4,5 and 27 mm by the method of up to the aortic noncoronary cusp insertion point. 16,22 This is of paramount importance as leaflet elongation itself makes less effective the papillary muscle capability of leaflet systolic restrain, ). This corresponds to +3% and +12%, respectively, relative to the averaged means of echoand CMR-derived values.…”

Section: Mitral Valvementioning

confidence: 99%

Structural abnormalities in hypertrophic cardiomyopathy beyond left ventricular hypertrophy by multimodality imaging evaluation

Urbano-Moral

Gutierrez-Garcia-Moreno²,

Rodríguez-Palomares³

et al. 2019

Echocardiography

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Background Echocardiography‐ and cardiovascular magnetic resonance (CMR)‐based studies have revealed a wide range of phenotypic manifestations in hypertrophic cardiomyopathy (HCM) apart from hypertrophy. This study sought to comprehensively describe a number of structural abnormalities in HCM beyond hypertrophy, by multimodality imaging. Methods A total of 100 HCM patients were prospectively enrolled, undergoing standard and contrast echocardiography, and CMR. Morphological characteristics involving mitral valve leaflets (MVL), subvalvular apparatus, and left ventricular cavity and wall were investigated. Seventy healthy volunteers served as control population. Results As assessed by echo, MVLs were longer in HCM patients than in controls (anterior method 1: 24[22,28] vs 19[18,20] mm, P < 0.01; anterior method 2: 27[24, 29] vs 21[19, 23] mm, P < 0.01; posterior: 15[12,19] vs 14[13,15] mm, P < 0.01). Abnormal chordal attachment to anterior MVL, anterior papillary muscle displacement, and accessory apical‐basal muscle bundle were present in 42 (42%), 61 (61%), and 35 (35%) patients, respectively (P values vs controls <0.01); direct papillary muscle insertion into MVL and hypertrabeculation were found in two and five patients, respectively. Contrast echocardiography (n = 94) detected myocardial crypts in 15 patients (16%). Overall, 83% of HCM subjects had at least one of these phenotypic manifestations. Echocardiography and CMR agreement for MVL length was poor, while for structural characteristics was moderate to substantial (Cohen's Kappa: 0.53‐1.00). Except for posterior MVL length and hypertrabeculation, the phenotypic characteristics studied had acceptable reproducibility by echocardiography and CMR. Conclusions Structural abnormalities in HCM beyond hypertrophy are significantly common. Multimodality imaging approach to these HCM facets by echocardiography and CMR is feasible and desirable.

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“…В ряде публикаций предлагают в качестве верхней границы нормы использовать критерий 30 мм (в сег-менте A2) или 17 мм/м 2 [23][24][25]. По данным Klue H.G.…”

Section: б) избыточная длина передней створки митрального клапанаunclassified

Alcohol septal ablation: patient selection and rationality of its application

Kashtanov¹,

Chernyshev²,

Kardapoltsev³

et al. 2017

PKiK

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The article looks at some aspects of selecting patients with obstructive hypertrophic cardiomyopathy for alcohol septal ablation (ASA) procedure. Based on the world’s experience and in the context of evidence-based medicine, the current positions of ASA in complex treatment of obstructive hypertrophic cardiomyopathy are described. Received 29 September 2016. Accepted 9 January 2017.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsData collection and analysis: Kashtanov M.G. Drafting the article: Kashtanov M.G. Critical revision: Kashtanov M.G., Idov E.M., Chernyshev S.D., Kardapoltsev L.V., Berdnikov S.V.

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Echocardiography before and after Resect-Plicate-Release Surgical Myectomy for Obstructive Hypertrophic Cardiomyopathy

Cited by 53 publications

References 34 publications

Hypertrophic cardiomyopathy with dynamic obstruction and high left ventricular outflow gradients associated with paradoxical apical ballooning

Hypertrophic cardiomyopathy with dynamic obstruction and high left ventricular outflow gradients associated with paradoxical apical ballooning

Structural abnormalities in hypertrophic cardiomyopathy beyond left ventricular hypertrophy by multimodality imaging evaluation

Alcohol septal ablation: patient selection and rationality of its application

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