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Indications and Outcome of Cardiac Surgery for Severely Symptomatic Patients with Hypertrophic Obstructive Cardiomyopathy

  • F. A. Schoendube
Conference paper

Abstract

Indication for surgical therapy in patients with hypertrophic cardiomyopathy is still agreed to be restricted to patients with severe symptoms refractory to medical treatment and with significant obstruction to the left ventricular outflow tract (basal gradients > 50 mmHg or > 80 mmHg after provocative manoeuvres) [1,2]. Relevant morbidity (ventricular septal perforation, atrioventricular block) and early mortality represent inherent risks with classical myotomy-myectomy [3], and recognition of subgroups with even elevated risk or with less benefit due to incomplete relief in addition suggests a cautious indication of surgery. A variety of surgical approaches have tried to overcome limitations, but none of them has gained general acceptance. Especially this holds true for mitral valve replacement [4], as notably patients are then faced with the long-term risks of thromboembolism, haemorrhage or other valve related complications. With a modified technique [5–7], which enables better exposure of the basal septum, simplifies myectomy and even allows to extend myectomy to the lateral free wall of the ventricle, attempts were made to obtain safe access to the deeper parts of the ventricle. Transaor-tic resection of hypertrophied trabeculae and mobilisation or partial excision of papillary muscles become thus feasible and may result in a reliable correction of the patho-anatomic distortions of the subvalvular mitral apparatus in hypertrophie cardiomyopathy.

Keywords

Papillary Muscle Hypertrophic Cardiomyopathy Mitral Valve Replacement Left Ventricular Outflow Tract Hypertrophic Obstructive Cardiomyopathy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Spirito P, Seidman, CE, McKenna WJ, Maron BJ (1997) The management of hypertrophic cardiomyopathy. N Engl J Med 336:775–785PubMedCrossRefGoogle Scholar
  2. 2.
    McIntosh CI, Maron BJ (1988) Current operative treatment of obstructive hypertrophic cardiomyopathy. Circulation 78:487–495PubMedCrossRefGoogle Scholar
  3. 3.
    Morrow AG, Reitz BA, Epstein SE, Conkle DM, Itscoitz SB, Redwood DR (1975) Operative treatment in hypertrophic subaortic stenosis. Techniques and the results of pre-and postoperative assessment in 83 patients. Circulation 52:88–102Google Scholar
  4. 4.
    Cooley DA, Leachmann RD, Hallmann GL (1971) IHSS: Surgical treatment including mitral valve replacement. Arch Surg 17:606–612CrossRefGoogle Scholar
  5. 5.
    Messmer BJ (1994) Extended myectomy for hypertrophie obstructive cardiomyopathy. Ann Thorac Surg 58:575–577PubMedCrossRefGoogle Scholar
  6. 6.
    Schoendube, FA, Klues HG, Reith S, Messmer BJ (1994) Surgical correction of hypertrophic obstructive cardiomyopathy with combined myectomy, mobilisation and partial excision of the papillary muscles. Eur J Cardiothorac Surg 8:603–608PubMedCrossRefGoogle Scholar
  7. 7.
    Schoendube FA, Klues HG, Reith, S, Flachskampf FA, Hanrath P, Messmer BJ (1995) Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation 92 (Suppl 2):II122–127PubMedGoogle Scholar
  8. 8.
    Beahrs MM, Abdul JT, Seward JB, Guiliani ER, McGoon DC (1983) HOCM: 10 to 21 year follow-up after partial septal myectomy. Am J Cardiol 51:1160–1166PubMedCrossRefGoogle Scholar
  9. 9.
    Seiler C, Hess OM, Schoenbeck M, Turina J, Jenni R, Turina M, Krayenbuehl HP (1991) Long-term follow-up of medical versus surgical therapy for hypertrophie cardiomyopathy: a retrospective study. J Am Coll Cardiol 17:634–642PubMedCrossRefGoogle Scholar
  10. 10.
    Ten Berg JM, Maarten JS, Knaepen PJ, Ernst SM, Vermeulen FE, Jaarsma W (1994) Hypertrophic obstructive cardiomyopathy: Initial results and long-term follow-up after Morrow septal myectomy. Circulation 90:1781–1785PubMedCrossRefGoogle Scholar
  11. 11.
    Robbins RC, Stinson EB (1996) Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophie cardiomyopathy. J Thorac Cardiovasc Surg 111:586–594PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia 1998

Authors and Affiliations

  • F. A. Schoendube

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