Transaortic septal myectomy: techniques and pitfalls

Ralph-Edwards, Anthony; Vanderlaan, Rachel D.; Bajona, Pietro

doi:10.21037/acs.2017.07.08

Cited by 22 publications

(22 citation statements)

References 4 publications

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“…Heart tissue was obtained from 29 patients with classical AVS undergoing aortic valve replacement and septal, subvalvular left ventricular myocardial resection according to the Morrow technique 18 , 19 . Right atrial samples were taken from the right atrial appendage from the venous cannulation site 19 . Tissue was immediately fixed in 4.5% buffered formalin and embedded in paraffin.…”

Section: Methodsmentioning

confidence: 99%

Proteomic mapping of atrial and ventricular heart tissue in patients with aortic valve stenosis

Barbarics

Eildermann

Kaderali

et al. 2021

Sci Rep

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Aortic valve stenosis (AVS) is one of the most common valve diseases in the world. However, detailed biological understanding of the myocardial changes in AVS hearts on the proteome level is still lacking. Proteomic studies using high-resolution mass spectrometry of formalin-fixed and paraffin-embedded (FFPE) human myocardial tissue of AVS-patients are very rare due to methodical issues. To overcome these issues this study used high resolution mass spectrometry in combination with a stem cell-derived cardiac specific protein quantification-standard to profile the proteomes of 17 atrial and 29 left ventricular myocardial FFPE human myocardial tissue samples from AVS-patients. In our proteomic analysis we quantified a median of 1980 (range 1495–2281) proteins in every single sample and identified significant upregulation of 239 proteins in atrial and 54 proteins in ventricular myocardium. We compared the proteins with published data. Well studied proteins reflect disease-related changes in AVS, such as cardiac hypertrophy, development of fibrosis, impairment of mitochondria and downregulated blood supply. In summary, we provide both a workflow for quantitative proteomics of human FFPE heart tissue and a comprehensive proteomic resource for AVS induced changes in the human myocardium.

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Section: Methodsmentioning

confidence: 99%

Proteomic mapping of atrial and ventricular heart tissue in patients with aortic valve stenosis

Barbarics

Eildermann

Kaderali

et al. 2021

Sci Rep

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“…They chose this approach for HOCM patients just because of suboptimal exposure through the traditional trans-aortic approach. As we all know, a satisfactory procedure for HOCM consists of three major goals: completely thickened septal muscle resection, dealing with the anterior mitral valve lea et in avoid of postoperative SAM, and release of abnormal papillary muscle and chordae attachments [8,9,11,12,13]. Compared with the traditional trans-aortic approach via the aortic incision, the trans-mitral approach via the base of the anterior mitral lea et provided a more clear panoramic exposure of the interventricular septum, making myectomy easily and avoiding heart block [14,15], through this approach, experienced surgeons could even identify the pale brous hinges subaortic hit caused by SAM [16,17,18].…”

Section: Discussionmentioning

confidence: 99%

Enlargement of left ventricular outflow tract using an autologous pericardial patch for anterior mitral valve leaflet and septal myectomy through trans‐mitral approach for the treatment of hypertrophic obstructive cardiomyopathy

Zhang

Zhu

Wang

et al. 2021

Journal of Cardiac Surgery

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Background: Modi ed Morrow procedure is the gold standard of surgical intervention for hypertrophic obstructive cardiomyopathy (HOCM). However, there are certain cases without clear exposure through the traditional trans-aortic approach; we therefore described a trans-mitral approach by enlarging left ventricular out ow tract (LVOT) using an autologous pericardial patch for the anterior mitral valve lea et and septal myectomy. We aimed to retrospectively analyze this series of patients to reveal its safety and e ciency.Methods: We retrospectively analyzed 16 HOCM patients underwent enlargement of LVOT using an autologous pericardial patch for the anterior mitral valve lea et and septal myectomy through transmitral approach in our center from January, 2016 to December, 2019. Baseline characteristics, operative details and postoperative data were extracted from our hospital medical records.Results: Of the 16 patients, there was no operative mortality. No new onset atrial brillation, no new onset stroke with symptoms, no permanent pacemaker implantation and no ventricular septal defects formation were observed during operation and three months follow-up. The peak pressure gradient of LVOT decreased from 97.56±23.81 mmHg to 7.56±2.13 mmHg (P < 0.01) after operation and 10.19±2.93 mmHg (P < 0.01) three months after operation. The average aortic cross-clamp time was 54.56±6.10 mins (range, 48 to 69 minutes). The systolic anterior motion (SAM) sign disappeared uneventfully in all cases. No patients had more than moderate MR.Conclusions: Enlargement of LVOT using an autologous pericardial patch for the anterior mitral valve lea et and septal myectomy through trans-mitral approach is feasible and reliable for the treatment of certain types of HOCM cases.Trial registration: Not applicable.

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“…Although there are many different surgical approaches and methods, the modi ed Morrow procedure through trans-aortic approach is still considered as the gold standard surgical treatment, showing a veri ed surgical result and good remission of symptoms for a long time [8,9,11]. The trans-mitral approach was rstly described in 1963 by Lillehei and Levy [10].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…For a long time, modi ed Morrow procedure has been the gold standard of surgical treatment, which was performed through the trans-aortic approach. In fact, in addition to modi ed Morrow operation through the transaortic approach, there are other approaches, including tans-apical and trans-mitral approach [9,10,11,12,13]. In clinical practice, we found many special cases, such as the aortic valve annulus is very small, the angle between the aortic valve annulus and the mitral valve annulus is less than 120 degrees, the anterior mitral lea et is too long, etc.…”

Section: Introductionmentioning

confidence: 95%

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Enlargement Of Left Ventricular Outflow Tract Using An Autologous Pericardial Patch For The Anterior Mitral Valve Leaflet And Septal Myectomy Through Trans-mitral Approach For The Treatment Of Hypertrophic Obstructive Cardiomyopathy

Zhang

Zhu

Wang

et al. 2020

Preprint

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Background: Modified Morrow procedure is the gold standard of surgical intervention for hypertrophic obstructive cardiomyopathy (HOCM). However, there are certain cases without clear exposure through the traditional trans-aortic approach; we therefore described a trans-mitral approach by enlarging left ventricular outflow tract (LVOT) using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy. We aimed to retrospectively analyze this series of patients to reveal its safety and efficiency.Methods: We retrospectively analyzed 16 HOCM patients underwent enlargement of LVOT using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach in our center from January, 2016 to December, 2019. Baseline characteristics, operative details and postoperative data were extracted from our hospital medical records. Results: Of the 16 patients, there was no operative mortality. No new onset atrial fibrillation, no new onset stroke with symptoms, no permanent pacemaker implantation and no ventricular septal defects formation were observed during operation and three months follow-up. The peak pressure gradient of LVOT decreased from 97.56±23.81 mmHg to 7.56±2.13 mmHg (P < 0.01) after operation and 10.19±2.93 mmHg (P < 0.01) three months after operation. The average aortic cross-clamp time was 54.56±6.10 mins (range, 48 to 69 minutes). The systolic anterior motion (SAM) sign disappeared uneventfully in all cases. No patients had more than moderate MR.Conclusions: Enlargement of LVOT using an autologous pericardial patch for the anterior mitral valve leaflet and septal myectomy through trans-mitral approach is feasible and reliable for the treatment of certain types of HOCM cases.Trial registration: Not applicable.

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Transaortic septal myectomy: techniques and pitfalls

Cited by 22 publications

References 4 publications

Proteomic mapping of atrial and ventricular heart tissue in patients with aortic valve stenosis

Proteomic mapping of atrial and ventricular heart tissue in patients with aortic valve stenosis

Enlargement of left ventricular outflow tract using an autologous pericardial patch for anterior mitral valve leaflet and septal myectomy through trans‐mitral approach for the treatment of hypertrophic obstructive cardiomyopathy

Enlargement Of Left Ventricular Outflow Tract Using An Autologous Pericardial Patch For The Anterior Mitral Valve Leaflet And Septal Myectomy Through Trans-mitral Approach For The Treatment Of Hypertrophic Obstructive Cardiomyopathy

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