Hypertrophic obstructive cardiomyopathy and its outcome following surgical myectomy: a retrospective study

Authors

  • Vedanth Gopalan Department of CTVS, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Kalaburagi, Karnataka, India
  • Pavaneel Bhandari Department of Cardiothoracic surgery, Apollo Hospitals, Hyderabad, Telangana, India
  • Anant A. Takalkar Department of Community Medicine, MIMSR Medical College and YCRH, Latur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20200563

Keywords:

Hypertrophic obstructive cardiomyopathy, Outcome, Surgical myectomy

Abstract

Background: Hypertrophic cardiomyopathy is highly heterogeneous with a diverse anatomy, pathophysiology, and clinical course. It is obstruction to left ventricular outflow that has become the major hallmark of the disease. Septal myectomy has been the gold standard treatment for the relief of left ventricular outflow tract obstruction and cardiac symptoms in both adults and children with obstructive hypertrophic cardiomyopathy. Objective of the study was to evaluate effect of Myomectomy and its impact on survival for a period of one year.

Methods: The study design is a retrospective record based observational study. Data was retrieved from previous records both electronic as well as manual records of all the patients who underwent myectomy with or without concomitant procedures such as mitral valve replacement or aortic valve replacement or coronary artery bypass surgery during 2014 to 2018.

Results: Majority of the patients 11 (52.4%) in fourth decade i.e. 40-59 years age group. majority were males i.e. 16 (76.2%) and remaining 5 i.e. 23.8% were females. Male to female ratio was 3.2:1. Dyspnoea was present 81% and chest pain in 76.2%. Preoperative LVOT gradient was 86.86±20.33 and post-operative gradient was 23.47±20.49.

Conclusions: Operative techniques have evolved from simple myotomy to the present method of extended septal myectomy which can be done in all adult cases of hypertrophic obstructive cardiomyopathy.

 

References

Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC Guidelines on Diagnosis and Management of Hypertrophic Cardiomyopathy. Revi Españ Cardiol. 2015;68(1):63.

Gersh BJ, Maron BJ, Bonow RO, Dearani JA, Fifer MA, Link MS, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines developed in collaboration with the American Association for Thoracic Surgery, American Society of echocardiography, American Society of nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2011;58(25):212-60.

Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet. 2013;381(9862):242-55.

Nishimura RA, Holmes Jr DR. Hypertrophic obstructive cardiomyopathy. New Eng J Med. 2004;350(13):1320-7.

Marian AJ, Braunwald E. Hypertrophic cardiomyopathy: genetics, pathogenesis, clinical manifestations, diagnosis, and therapy. Circul Res. 2017;121(7):749-70.

Maron BJ. Sudden death in hypertrophic cardiomyopathy. J Cardio Trans Res. 2009;2(4):368-80.

Braunwald E, Lambrew CT, Rockoff SD, Ross J Jr, Morrow AG. Idiopathic hypertrophic subaortic stenosis. I. A description of the disease based upon an analysis of 64 patients. Circulation. 1964;30:3-119.

Wigle ED, David PR, Labrosse CJ, McMeekan J. Muscular subaortic stenosis: the interrelation of wall tension, outflow tract “distending pressure” and orifice radius. Am J Cardiol. 1965;15(6):761-72.

Maron MS, Olivotto I, Zenovich AG, Link MS, Pandian NG, Kuvin JT, et al. Clinical perspective. Circulation. 2006;114(21):2232-9.

Curila K, Benesova L, Penicka M, Minarik M, Zemanek D, Veselka J, et al. Spectrum and clinical manifestations of mutations in genes responsible for hypertrophic cardiomyopathy. Acta Cardiol. 2012;67(1):23-9.

Maron BJ, Gardin JM, Flack JM, Gidding SS, Kurosaki TT, Bild DE. Prevalence of hypertrophic cardiomyopathy in a general population of young adults: echocardiographic analysis of 4111 subjects in the CARDIA study. Circulation. 1995;92(4):785-9.

Karam R, Lever HM, Healy BP. Hypertensive hypertrophic cardiomyopathy or hypertrophic cardiomyopathy with hypertension?: A study of 78 patients. J Am Coll Cardiol. 1989;13(3):580-4.

Topol EJ, Traill TA, Fortuin NJ. Hypertensive hypertrophic cardiomyopathy of the elderly. New Eng J Med. 1985;312(5):277-83.

Feiner E, Arabadjian M, Winson G, Kim B, Chaudhry F, Sherrid MV. Post-prandial upright exercise echocardiography in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2013;61(24):2487-8.

Paz R, Jortner R, Tunick PA, Sclarovsky S, Eilat B, Perez JL, et al. The effect of the ingestion of ethanol on obstruction of the left ventricular outflow tract in hypertrophic cardiomyopathy. New Eng J Med. 1996;335(13):938-41.

Maron BJ, Spirito P, Shen WK, Haas TS, Formisano F, Link MS, et al. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. Jama. 2007;298(4):405-12.

Wan CK, Dearani JA, Sundt III TM, Ommen SR, Schaff HV. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation?. Annal Thora Surg. 2009;88(3):727-32.

Downloads

Published

2020-02-26

Issue

Section

Original Research Articles