Mitral stenosis and hypertrophic obstructive cardiomyopathy: An unusual combination

Abstract

Patients with mitral stenosis and hypertrophic obstructive cardiomyopathy have multiple LVOT obstruction mechanisms, and MV replacement may not be adequate treatment. We favor septal myectomy and MV replacement in this complex subset of hypertrophic obstructive cardiomyopathy.

Myectomy and Left Atrial-to-Left Ventricular Conduit for Severe Calcific Mitral Stenosis and Hypertrophic Cardiomyopathy

“…Although most patients with obstructive HCM and calcific MV stenosis can undergo concomitant MV replacement [4], in our 2 patients this carried unacceptably high risk, and we opted to perform LA-to-LV bypass instead. This procedure is relatively simple to perform, and early studies demonstrate decompression of the left atrium and relief of symptoms.…”

“…In obstructive HCM, MV stenosis reduces LV preload, exacerbating dynamic LVOT obstruction and associated symptoms. MV replacement at the time of transaortic septal myectomy is preferred for most patients [4], but standard prosthetic MV replacement may be difficult when there is extensive annular calcification.…”

“…In young patients with hypertrophic cardiomyopathy (HCM), MV calcification is unusual, but it has been reported in 30% of patients aged 40 years or older [1]. In most cases of HCM with concomitant calcific MV stenosis, MV replacement can be performed safely [2][3][4]. However, there are circumstances (eg, congenital MV stenosis [5] or severe annular calcification) when MV replacement is not possible or carries excessive risks.…”

Accessory mitral valve tissue in association with bicuspid aortic valve and aortic coarctation

“…Vrodená stenóza mitrálnej chlopne však môže byť spôsobená aj s ďalšími malformáciami, ako sú supramitrálny anulus, fúzia komisúr, skrátené šlašinky, patologická mitrálna arkáda, anomálna pozícia papilárnych svalov a padákovitá mitrálna chlopňa [7][8][9][10][11]. Iné príčiny vrodenej obštrukcie LVOT zahŕňajú posun septa z dôvodu ľavo-pravého interkomorového tlakového gradientu, abnormality pulmonálnej chlopne, subvalvulárny fi bromuskulárny tunel, nadpočetné tkanivo trikuspidálnej chlopne, anomálny odstup šlašiniek mitrálnej chlopne, alebo papilárnych svalov smerom k LVOT, patológiu trikuspidálnej chlopne a hypertrofi u endokardu z dôvodu defektu komorového septa [4,12] valve tissue combined with trivial obstruction of left ventricle outflow tract (LVOT) was also present. AMVT with chordae was excised and mitral annuloplasty has been accomplished.…”

Transcatheter Mitral Valve Plication

“…(23,24). In addition, patient selection is important because elderly patients with obstructive HCM may have mitral annular calcification that can produce mitral stenosis (25), and valve narrowing might be worsened by leaflet plication.…”