Indications and Outcome of Cardiac Surgery for Severely Symptomatic Patients with Hypertrophic Obstructive Cardiomyopathy
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 , 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 , 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.
KeywordsPapillary Muscle Hypertrophic Cardiomyopathy Mitral Valve Replacement Left Ventricular Outflow Tract Hypertrophic Obstructive Cardiomyopathy
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