Paolo Ferrazzi1, Paolo Spirito2, Attilio Iacovoni3, Alice Calabrese3, Katrin Migliorati4, Caterina Simon5, Samuele Pentiricci5, Daniele Poggio4, Massimiliano Grillo4, Pietro Amigoni4, Maria Iascone6, Andrea Mortara4, Barry J Maron7, Michele Senni3, Paolo Bruzzi8. 1. Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy. Electronic address: paolo.ferrazzi@policlinicodimonza.it. 2. Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy. 3. USC Cardiologia, Ospedale Papa Giovanni XXIII, Bergamo, Italy. 4. Centro per la Cardiomiopatia Ipertrofica e le Cardiopatie Valvolari, Policlinico di Monza, Monza, Italy. 5. USC Cardiochirurgia, Ospedale Papa Giovanni XXIII, Bergamo, Italy. 6. Laboratorio Genetica Medica, Ospedale Papa Giovanni XXIII, Bergamo, Italy. 7. Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota. 8. Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
Abstract
BACKGROUND: In severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) and mild septal hypertrophy, mitral valve (MV) abnormalities may play an important role in MV displacement into the left ventricular (LV) outflow tract. Therefore, isolated myectomy may not relieve outflow obstruction and symptoms, and MV replacement is often the surgical alternative. OBJECTIVES: This study sought to assess the clinical and hemodynamic results of cutting thickened secondary MV chordae combined with a shallow septal muscular resection in severely symptomatic patients with obstructive HCM and mild septal hypertrophy. METHODS: Clinical features were compared before surgery and at most recent clinical evaluation in 39 consecutive patients with obstructive HCM. RESULTS: Over a 23 ± 2 months follow-up, New York Heart Association functional class decreased from 2.9 ± 0.5 pre-operatively to 1.1 ± 1.1 post-operatively (p < 0.001), with no patient in class III at most recent evaluation. The resting outflow gradient decreased from 82 ± 43 mm Hg to 9 ± 5 mm Hg (p < 0.001) and septal thickness decreased from 17 ± 1 mm to 14 ± 2 mm (p < 0.001). No patient had MV prolapse or flail and 1 had residual moderate-to-severe MV regurgitation at most recent evaluation. MV geometry before and after surgery was compared with that of 25 consecutive patients with similar clinical profile and septal thickness that underwent isolated myectomy. After adjustment for differences in pre-operative values between the groups, the post-operative anterior MV leaflet-annulus ratio was 17% greater and tenting area 24% smaller in patients with chordal cutting, indicating that MV apparatus had moved to a more normal posterior position within the LV cavity, preventing MV systolic displacement into the outflow tract and outflow obstruction. CONCLUSIONS: This procedure relieves heart failure symptoms, abolishes LV outflow gradient, and avoids MV replacement in patients with obstructive HCM and mild septal thickness.
BACKGROUND: In severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) and mild septal hypertrophy, mitral valve (MV) abnormalities may play an important role in MV displacement into the left ventricular (LV) outflow tract. Therefore, isolated myectomy may not relieve outflow obstruction and symptoms, and MV replacement is often the surgical alternative. OBJECTIVES: This study sought to assess the clinical and hemodynamic results of cutting thickened secondary MV chordae combined with a shallow septal muscular resection in severely symptomatic patients with obstructive HCM and mild septal hypertrophy. METHODS: Clinical features were compared before surgery and at most recent clinical evaluation in 39 consecutive patients with obstructive HCM. RESULTS: Over a 23 ± 2 months follow-up, New York Heart Association functional class decreased from 2.9 ± 0.5 pre-operatively to 1.1 ± 1.1 post-operatively (p < 0.001), with no patient in class III at most recent evaluation. The resting outflow gradient decreased from 82 ± 43 mm Hg to 9 ± 5 mm Hg (p < 0.001) and septal thickness decreased from 17 ± 1 mm to 14 ± 2 mm (p < 0.001). No patient had MV prolapse or flail and 1 had residual moderate-to-severe MV regurgitation at most recent evaluation. MV geometry before and after surgery was compared with that of 25 consecutive patients with similar clinical profile and septal thickness that underwent isolated myectomy. After adjustment for differences in pre-operative values between the groups, the post-operative anterior MV leaflet-annulus ratio was 17% greater and tenting area 24% smaller in patients with chordal cutting, indicating that MV apparatus had moved to a more normal posterior position within the LV cavity, preventing MV systolic displacement into the outflow tract and outflow obstruction. CONCLUSIONS: This procedure relieves heart failure symptoms, abolishes LV outflow gradient, and avoids MV replacement in patients with obstructive HCM and mild septal thickness.
Authors: Hassan Rastegar; Griffin Boll; Ethan J Rowin; Noreen Dolan; Catherine Carroll; James E Udelson; Wendy Wang; Philip Carpino; Barry J Maron; Martin S Maron; Frederick Y Chen Journal: Ann Cardiothorac Surg Date: 2017-07
Authors: Giuseppe M Raffa; Eluisa La Franca; Carlo Lachina; Andrea Palmeri; Mariusz Kowalewski; Steven Lebowitz; Alessandro Ricasoli; Matteo Greco; Sergio Sciacca; Marco Turrisi; Marco Morsolini; Vincenzo Stringi; Gabriella Mattiucci; Michele Pilato Journal: Front Cardiovasc Med Date: 2022-06-15
Authors: Victor Arévalos; Juan José Rodríguez-Arias; Salvatore Brugaletta; Antonio Micari; Francesco Costa; Xavier Freixa; Mónica Masotti; Manel Sabaté; Ander Regueiro Journal: J Clin Med Date: 2021-05-24 Impact factor: 4.241