Surgical Treatment of an Obstructive Hypertrophic Cardiomyopathy

Хирургическое лечение обструктивной гипертрофической кардиомиопатии.
Arystan Seidalin 1, Adilzhan Albazarov 1, Rahim Tojiboyev 1, Saule Nurakaeva 1, Ayana Sygay 1, Vladimir Dikolayev 1
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1 JSC “National Scientific Medical Research Center”, Astana, Kazakhstan
J CLIN MED KAZ, Volume 1, Issue 35, pp. 21-25.
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ABSTRACT

Research objective: Assessment of a surgical treatment modality for patients with an obstructive hypertrophic cardiomyopathy.
Methods: From 2013 to 2014 year cardiac surgery department of National Scientific Medical Research Center (Astana, Kazakhstan) performed 14 procedures for correction of an obstructive cardiomyopathy. Morrow procedure in isolated form or in combination with correction of other cardiac pathology had been utilized. Isolated form of Morrow procedure was used in 3 patients (21.4%), in other 11 cases in combination with coronary artery bypass surgery (CABG) – 3 (21,4%); CABG with mitral valve repair – 6 (42,8%); David procedure – 1 and a section of the myocardium muscular bridge – 1 case.
Results: Early and long-term results of surgical correction of an obstructive cardiomyopathy are presented. The average pressure gradient was 13.9 + 6 mm Hg (prior to operation of 79.7+61.3 mm Hg). Average thickness of the interventricular septum after myomectomy was 13.7 + 3.3 mm (prior to surgery 23.1+3.2 mm). In cases when correction of valve pathology was performed simultaneously, function of valves by echocardiographic control was also estimated (size of gradient and regurgitation). Satisfactory clinical results were obtained in 12 patients. Two patients died in early postoperative period.
Conclusions: We recommend expanded myomectomy techniques, as opposed to classical Morow procedure. Our department experience with these procedures shows that this approach leads to considerable clinical improvements in the patients with obstruction of the left ventricular outflow tract.

CITATION

Seidalin A, Albazarov A, Tojiboyev R, Nurakaeva S, Sygay A, Dikolayev V. Surgical Treatment of an Obstructive Hypertrophic Cardiomyopathy. Journal of Clinical Medicine of Kazakhstan. 2015;1(35):21-5.

REFERENCES

  • Borck R: Functional obstruction of the left ventricle (acquired aortic subvalvular stenosis), Guy’s Hospital Report, 1957, No.106, pp. 221-238.
  • Looden F, Kahn H, Gietzen F, Schulte HD, Birck W: Clinical course and prognosis of patients with typical and atypical hypertrophic obstructive cardiomyopathy and with non-obstructive cardiomyopathy, Eur Heart J, 1983, No.4, pp.145-153.
  • Williams WG: Combined anterior mitral leaflet extension and myectomy in hypertrophic obsctructive cardiomyopathy, Letter to the Editor, Circulation, 2004, No.109, pp.324.
  • Klues HG, Roberts WC, Maron BJ: Morphologic determinants of echocardiographic patterns of mitral valve systolic anterior motion in obstructive hypertrophic cardiomyopathy, Circulation, 1993, No.87, pp.1570-1579.
  • Maron BJ, Nishimura RA, Danielson GK: Pitfalls in clinical recognition and a novel operative approach for hypertrophic cardiomyopathy with severe outflow obstruction due to anomalous papillary muscle, Circulation, 1998, No.98, pp.2505-2508.
  • Minakata K, Dearani JA, Nishimura RA, et al: Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordate, J Thorac Cardiovasc Surg, 2004, No.127, pp.481-489.
  • Matsuda H, Nomura F, Kadoba K, et al: Transatrial and transmitral approach for left ventricular myectomy and mitral valve plication for diffuse type hypertrophic obstructive cardiomyopathy: A novel approach, J Thorac Cardio vasc Surg, 1996, No.112, pp.195-196.
  • Lillehei CW, Levy MJ: Transatrial exposure for correction of subaortic stenosis: A new approach, JAMA, 1963, 8, pp.186.
  • Ehrenhaft JL, Rossi NP, Vlad LP: Transatrial and transaortic approach to subvalvular left ventricular outflow tract obstruction: Correction of associated anomalies in children, Ann Surg, 1966 , No 164: рр. 418-427,
  • Theodoro DA, Danielson GK, Feldt RH, et al: Hypertrophic obstructive cardiomyopathy in pediatric patients: Results of surgical treatment. J Thorac Cardiovasc Surg, 1996, No.112(6), pp.1589-1597.