Transmitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Wehman, Brody; Ghoreishi, Mehrdad; Foster, Nathaniel; Wang, Yunlong; D’Ambra, Michael N.; Maassel, Nathan; Maghami, S A Ghaem; Quinn, Rachael W.; Dawood, Murtaza Y.; Fisher, Stacy D.; Gammie, James S.

doi:10.1016/j.athoracsur.2017.10.045

Cited by 26 publications

(23 citation statements)

References 28 publications

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“…This procedure is relatively simple to perform and prevents manipulations of the native anterior mitral leaflet, such as cutting, placement of stay sutures, and suturing of the leaflet to its annulus at the end of the procedure. Moreover, the potential risks of injury to the conduction system 11 and aortic cusps and failure of mitral repair due to laceration or perforation of the anterior leaflet can be avoided. Because of no suturing of the leaflet and associated fibrosis, the mobility and height of the anterior mitral leaflet are preserved with this approach and these are important factors for the long-term durability of valve repair.…”

Section: Discussionmentioning

confidence: 99%

Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Onan

Kadiroğulları

Kahraman

et al. 2019

Innovations�(Phila)

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Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

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Section: Discussionmentioning

confidence: 99%

Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Onan

Kadiroğulları

Kahraman

et al. 2019

Innovations�(Phila)

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“…Some authors believe that the hypertrophy of one or two papillary muscles up to 1.1 cm in either vertical or horizontal diameters can be a manifestation of independent HCM phenotype [18,28]. However, current literature data on the involvement of anterior cusp of the mitral valve in the pathogenesis of heart failure in HCM [4,[29][30][31][32][33] presuppose that changes in papillary muscles may be secondary to the morphofunctional features of the cusps and chordae of the mitral valve in this pathology.…”

Section: The Objectivementioning

confidence: 99%

Myocardial morphology in hypertrophic cardiomyopathy: the current state of the problem

Balabai

2019

ZMJ

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Цель работы -на основании данных современных источников научной литературы проанализировать морфологические особенности миокарда при гипертрофической кардиомиопатии.Обзор освещает современные взгляды на особенности структурного ремоделирования миокарда левого желудочка сердца у больных гипертрофической кардиомиопатией, приведены наиболее распространенные классификации данной патологии. Уделено внимание проблеме взаимосвязи фигур дизарея кардиомиоцитов и фиброза миокарда. Важное патогенетическое звено развития сердечной недостаточности, усиливающее связь между нарушениями гистоархитектоники миокарда и прогрессирующей ишемией сердца при гипертрофической кардиомиопатии -«болезнь малых сосудов».Выводы. Несмотря на большое количество исследований гипертрофической кардиомиопатии, в научной литературе нет единого мнения об этиологии и патогенезе гипертрофической кардиомиопатии. Противоречивые сведения о наличии взаимосвязи и последовательности развития фигур дизарея, гипертрофии кардиомиоцитов, интерстициального фиброза, изменений микроциркуляторного русла и митрального клапана при гипертрофической кардиомиопатии затрудняют поиски адекватного этиотропного лечения. Полиморфизм клинических и морфологических проявлений гипертрофической кардио миопатии требует от кардиологов и патогистологов совместных усилий по изучению данной болезни.A -research concept and design; B -collection and/or assembly of data; C -data analysis and interpretation; D -writing the article; E -critical revision of the article; F -final approval of the article The objective. Based on the modern sources of scientific data to analyze the morphological features of the myocardium in hypertrophic cardiomyopathy.The paper presents a literature review on current views on the features of structural remodeling of the left ventricular myocardium in patients with hypertrophic cardiomyopathy, as well as the most common classifications of this pathology. The emphasis is made on the problem of the interrelation of myocardial disarray and fibrosis.The "small vessel disease" is an important pathogenetic link in the development of heart failure, which enhances the relation between disorder of myocardial histoarchitectonics and progressive cardiac ischemia in hypertrophic cardiomyopathy. Conclusions.Notwithstanding the numerous research data on hypertrophic cardiomyopathy, no consensus among the authors regarding the etiology and pathogenesis of hypertrophic cardiomyopathy exists to date. Controversial data on the interrelation and sequence of disarray, myocardial hypertrophy, interstitial fibrosis, changes in the microvasculature and structural changes of the mitral valve in patients with hypertrophic cardiomyopathy hamper the search for adequate etiotropic treatment.Polymorphism of clinical and morphological manifestations of hypertrophic cardiomyopathy requires collaborative efforts to study the disease by cardiologists and pathologists.Морфологія міокарда при гіпертрофічній кардіоміопатії: сучасний стан проблеми А. А. Балабай Мета роботи -на підставі даних сучасни...

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“…При этом глубина продольных разрезов увеличивалась до появления свечения тканей, свидетельствующего о достижении целевой остаточной толщины миокарда (рис. 5,6).…”

Section: описание экспериментовunclassified

“…В связи с ограниченной анатомической доступностью межжелудочковой перегородки (МЖП) был предложен ряд внутрисердечных доступов. Наиболее часто используется доступ через створ аортального клапана [2], значительно реже применяются доступы через правый желудочек [4], левое предсердие и митральный клапан [5], трансапикальный доступ -через верхушку левого желудочка [6]. Разработаны специальные хирургические инструменты -различные виды крючков, ножей, ретракторов [7][8][9].…”

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The way to control the interventricular septum thickness during septal myectomy. An experimental study

et al. 2019

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Background: At present, there are no methods for intraoperative monitoring of the interventricular septum (IVS) thickness in a stopped and empty heart. This might be an obvious reason for unsatisfactory results after a number of septal myectomies.Aim: To provide an experimental background for the method to control the IVS thickness (that we had proposed) during septal myectomy.Materials and methods: The proposed technique is based on the transillumination method. The experimental models were cadaveric porcine hearts, as well as fragments of the human myocardium removed during septal myectomies. The thickness of the translucent myocardium was estimated depending on the local illumination value at the entrance to the myocardium and the external illumination of the surgical field. We compared the results of 67 septal myectomies performed in the clinic of the Almazov National Medical Research Centre with the results of 35 similar experimental procedures with cadaveric porcine hearts using the proposed way of measurement.Results: A graph of the illumination at the entrance to the myocardium against the thickness of the translucent myocardium was constructed. After conventionally performed septal myectomies the median variation of the myocardial thickness was 4 [3; 6] mm. In the experiment using the proposed control method, the median variation was 1 [1; 2] mm, i.e. significantly less than with the conventional approach (p = 3 x 10-10).Conclusion: The method to control the IVS thickness when performing septal myectomy makes it possible to achieve the required myocardial thickness the resection area with much greater accuracy than with the conventional one.

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Transmitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Cited by 26 publications

References 28 publications

Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Robotic Septal Myectomy Without Anterior Leaflet Incision during Mitral Valve Repair

Myocardial morphology in hypertrophic cardiomyopathy: the current state of the problem

The way to control the interventricular septum thickness during septal myectomy. An experimental study

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