Septal myomectomy and mitral valve replacement for idiopathic hypertrophic subaortic stenosis: Short- and long-term follow-up

Abstract

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)

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

“…Current national and international practice still commonly involves concomitant mitral valve intervention to manage MR associated with HCM (58)(59)(60)(61)(62). However, in our experience, a mitral valve procedure is generally the exception rather than the norm in HCM.…”

Estenose mitral grave como evolução a longo prazo de miotomia/miectomia septal cirúrgica

“…Asymmetric septal hypertrophic cardiomyopathy is usually greatly heterogeneous in its morphology, its clinical features, and its evolution [1][2][3][4] . In a considerable number of cases, asymmetric septal hypertrophic cardiomyopathy has been reported in association with valvular changes, mostly mitral insufficiency, which usually resolves after myotomy-myectomy-septal resection is performed [2][3][4][5]8 .…”

“…In a considerable number of cases, asymmetric septal hypertrophic cardiomyopathy has been reported in association with valvular changes, mostly mitral insufficiency, which usually resolves after myotomy-myectomy-septal resection is performed [2][3][4][5]8 . More commonly, the mitral insufficiency occurring in asymmetric septal hypertrophic cardiomyopathy follows the obstruction caused by the systolic anterior motion of the mitral valve [2][3][4]8 .…”

“…Myotomy-myectomy-septal resection was indicated and performed through an aortotomy. The anatomicopathological study of the left ventricular fragments removed during the surgery showed hypertrophic cardiomyocytes and areas of disarrangement and Hypertrophic cardiomyopathy, also known as idiopathic hypertrophic subaortic stenosis or hypertrophic obstructive cardiomyopathy, is a disease classically characterized by nondilated left ventricular hypertrophy in the absence of any other cause of increase in myocardial mass [1][2][3][4] . Its incidence in the general population ranges from 0.02% to 5% 1,5 .…”

“…ment and are indicated for more aggressive therapies, such as myotomy-myectomy-septal resection, dual-chamber pacemaker implantation, alcohol injection in the septal artery, defibrillator implantation (used in cases at high risk for sudden death), and even heart transplantation 3,4 .…”