Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae

Minakata, Kenji; Dearani, Joseph A.; Nishimura, Rick A.; Maron, Barry J.; Danielson, Gordon K.

doi:10.1016/j.jtcvs.2003.09.040

Cited by 193 publications

(146 citation statements)

References 21 publications

Supporting

Mentioning

140

Contrasting

Unclassified

Order By: Relevance

“…Consequently, outflow tract obstruction and MR may persist after successful surgical myectomy. To counteract residual SAM, several authors (22)(23)(24) reported MV replacement as an alternative procedure in patients regarded as less suitable candidates for septal myectomy. In our institution, while we agree that the mitral valvular dysfunction is an integral factor in producing outflow obstruction, replacing the valve is not imperative either for reduction of the outflow gradient or for alleviation of mitral insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of simultaneous septal myectomy and anterior mitral leaflet retention plasty in hypertrophic obstructive cardiomyopathy: the Berlin experience

Walter¹,

Javier²,

Hetzer³

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

Background: Various surgical strategies designed to relieve left ventricular outflow tract obstruction (LVOTO) and correct mitral regurgitation (MR) in hypertrophic obstructive cardiomyopathy (HOCM) have evolved, yet reports on the long-term outcomes of each technique are scarce. We provide an update on over 20 years' experience at our institution in the standardized surgical treatment of HOCM. (median 12, range 1-23.2 years), MR was trivial in 87% and SAM was non-existent in all, outcomes that were maintained at the latest follow-up. Two patients underwent mitral valve (MV) replacement 1 and 5 years after ALRP for recurrent MR. Two patients eventually underwent heart transplantation for end-stage heart failure, 2 and 11 years later, respectively. Twenty-year freedom from repeat MV intervention and cumulative survival rate was 92.9% and 91.2%, respectively.Conclusions: Long-term follow up of HOCM patients who underwent simultaneous septal myectomy and ALRP showed sustained absence of SAM, attenuation of MI, absence of residual LVOT obstruction and sustained improvement in hemodynamic and functional status.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term outcome of simultaneous septal myectomy and anterior mitral leaflet retention plasty in hypertrophic obstructive cardiomyopathy: the Berlin experience

Walter¹,

Javier²,

Hetzer³

2017

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…6 Septal myectomy is traditionally performed through an aortotomy, creating a rectangular trough (usually 3.5 to 5.0 cm in length) by 2 parallel longitudinal incisions in the basal septum (2 to 3.5 cm apart). These incisions are extended distally and connected just beyond the point of mitral-septal contact and obstruction (Morrow procedure) 5 or at the bases of papillary muscles (extended myectomy), 14 yielding a residual septal thickness of 8 to 10 mm and 3 to 15 g of septal muscle, and thereby enlarging the outflow tract and abolishing systolic contact between the mitral valve and the septum. 3,4 Long and extensive experience and the substantial data assembled from Ͼ25 centers worldwide have made septal myectomy an established and reliable strategy for patients of any age with HCM.…”

Section: Surgical Experiencementioning

confidence: 99%

“…Furthermore, only the surgical approach affords the flexibility under direct anatomic visualization that is often necessary to achieve complete repair and relief of subaortic obstruction, given the complex LV outflow tract morphology frequently encountered in HCM. 14 In contrast, alternative catheter-based techniques such as alcohol septal ablation are anatomically restricted to the size and distribution of the septal perforator coronary artery. 16 -19 Furthermore, accumulating evidence from nonrandomized studies indicates that myectomy also provides a long-term survival benefit that is indistinguishable from that of the general population and superior to nonoperated patients with obstruction and therefore may alter the natural history of HCM.…”

Section: Surgical Experiencementioning

confidence: 99%

See 1 more Smart Citation

Surgery for Hypertrophic Obstructive Cardiomyopathy

Maron

2005

Circulation

View full text Add to dashboard Cite

“…4 However, excellent results were reported by others, using extended septal myectomy. 5 Alternatively, limited septal myectomy and patch reconstruction show good late results with a low operative risk. 3 …”

Section: Responsementioning

confidence: 99%

Combined Anterior Mitral Leaflet Extension and Myectomy in Hypertrophic Obstructive Cardiomyopathy

Williams

2004

Circulation

View full text Add to dashboard Cite

Dr van der Lee et al 1 describe a combined operative procedure for treating patients with obstructive hypertrophic cardiomyopathy. As well as a "standard" subaortic myectomy, they added a glutaraldehydetreated autologous pericardial patch to the anterior leaflet of the mitral valve. The authors applied their combined technique to 29 of the last 32 patients accepted for surgical correction.The mitral valve, specifically the systolic anterior motion of the mitral valve leaflets, is an important component of the obstruction. However, the mitral valve is almost always intrinsically normal, albeit with the exceptions we had previously described. 2 Adequate relief of the outflow tract stenosis by generous myectomy will almost invariably restore normal function of the mitral valve apparatus. 3 Only in those situations in which the mitral valve is intrinsically abnormal should one consider additional procedures involving the mitral valve. In our clinical experience, mitral valve repair or replacement has been required in only 3.4% of surgical myectomy patients.Myectomy alone should completely relieve the outflow tract gradient both at rest and with provocation. In the authors' series, the septal thickness on average was reduced from 23 to 18 mm. The normal septal thickness in an adult is Ͻ12 mm, and we routinely excise sufficient septal muscle to leave a residual septal thickness within the normal range. This results in a resting mean gradient of 7 mm Hg and provocable gradient after extrasystole of Ͻ15. Mitral valve regurgitation after myectomy is absent or mild in 95% of patients.We have previously reported patch enlargement of the mitral leaflets to relieve subaortic stenosis in the setting of atrioventricular septal defect. 4 Although application of this procedure to patients with hypertrophic obstructive cardiomyopathy may be indicated in very rare situations, it would be a disservice to our patients to suggest it be used routinely. While the authors are to be congratulated in demonstrating the efficacy of enlarging the anterior mitral leaflet in hypertrophic obstructive cardiomyopathy patients, a word of caution is necessary in limiting its use to exceptional circumstances. William G. Williams, MD ResponseDuring the last decade major progress has been made in our understanding of the mechanisms of disease in hypertrophic obstructive cardiomyopathy (HOCM). Mitral valve replacement has been replaced by transaortic left ventricular septal myectomy. The myectomy trough extends more to the apex, and a residual midventricular gradient may be prevented by resection of the base of the papillary muscle. Abnormal papillary muscle insertion in the mitral leaflet, intrinsic mitral regurgitation caused by prolapse, and limited basal septal thickness (Ͻ18 mm) are no longer indications for mitral valve replacement as in the past. Despite these refinements, some patients have residual systolic anterior motion of the mitral valve and suboptimal clinical results. 1 The mitral valve in HOCM usually has an increased length of the...

show abstract

Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae

Cited by 193 publications

References 21 publications

Long-term outcome of simultaneous septal myectomy and anterior mitral leaflet retention plasty in hypertrophic obstructive cardiomyopathy: the Berlin experience

Long-term outcome of simultaneous septal myectomy and anterior mitral leaflet retention plasty in hypertrophic obstructive cardiomyopathy: the Berlin experience

Surgery for Hypertrophic Obstructive Cardiomyopathy

Combined Anterior Mitral Leaflet Extension and Myectomy in Hypertrophic Obstructive Cardiomyopathy

Contact Info

Product

Resources

About