Filip Dulguerov1, Cecilia Marcacci1, Clara Alexandrescu1, K M John Chan2, Gilles D Dreyfus3. 1. Cardiothoracic Center of Monaco, Monaco Cedex, Monaco. 2. Cardiothoracic Center of Monaco, Monaco Cedex, Monaco National Heart and Lung Institute, Imperial College London, London, UK Sarawak General Hospital Heart Center, Kuching, Sarawak, Malaysia. 3. Cardiothoracic Center of Monaco, Monaco Cedex, Monaco National Heart and Lung Institute, Imperial College London, London, UK gdreyfus@ccm.mc.
Abstract
OBJECTIVES: As we strongly believe that treating the mitral valve abnormalities is a key feature of hypertrophic obstructive cardiomyopathy (HOCM), we have systematically corrected both the anterior and posterior leaflet (PL) size and geometry. We have analysed our immediate results and at mid-term follow-up. METHODS: From March 2010 until June 2015, 16 patients with HOCM underwent surgical correction of obstruction. The mean age was 51 years old (range, 32-72 years). All were symptomatic being New York Heart Association (NYHA) class 3 (n = 4) or 4 (n = 12). All had systolic anterior motion at echocardiogram with severe mitral regurgitation (MR). Intraventricular gradient preoperatively was 73.5 mmHg (range, 50-120 mmHg). All patients underwent a double-stage procedure: first septal resection through (i) the aortic valve and (ii) the detached anterior leaflet (AL) of the mitral valve and at second, mitral valve repair by (i) reducing PL height (leaflet resection or artificial neochordae) (ii) increasing AL height with pericardial patch. RESULTS: There was no in-hospital or late death. All patients were Class 1 NYHA at latest follow-up. Control echocardiography showed no MR, mean rest intraventricular gradient was 15 mmHg (range, 9-18 mmHg). CONCLUSIONS: Our good mid-term results support the concept that HOCM is not only a septal disease and that the mitral valve pathology is a key component that should be addressed. For most patients, the ideal surgical treatment should consist in a two-step procedure. It is even necessary to be studied whether treating the mitral valve alone could not suffice.
OBJECTIVES: As we strongly believe that treating the mitral valve abnormalities is a key feature of hypertrophic obstructive cardiomyopathy (HOCM), we have systematically corrected both the anterior and posterior leaflet (PL) size and geometry. We have analysed our immediate results and at mid-term follow-up. METHODS: From March 2010 until June 2015, 16 patients with HOCM underwent surgical correction of obstruction. The mean age was 51 years old (range, 32-72 years). All were symptomatic being New York Heart Association (NYHA) class 3 (n = 4) or 4 (n = 12). All had systolic anterior motion at echocardiogram with severe mitral regurgitation (MR). Intraventricular gradient preoperatively was 73.5 mmHg (range, 50-120 mmHg). All patients underwent a double-stage procedure: first septal resection through (i) the aortic valve and (ii) the detached anterior leaflet (AL) of the mitral valve and at second, mitral valve repair by (i) reducing PL height (leaflet resection or artificial neochordae) (ii) increasing AL height with pericardial patch. RESULTS: There was no in-hospital or late death. All patients were Class 1 NYHA at latest follow-up. Control echocardiography showed no MR, mean rest intraventricular gradient was 15 mmHg (range, 9-18 mmHg). CONCLUSIONS: Our good mid-term results support the concept that HOCM is not only a septal disease and that the mitral valve pathology is a key component that should be addressed. For most patients, the ideal surgical treatment should consist in a two-step procedure. It is even necessary to be studied whether treating the mitral valve alone could not suffice.
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: Mihaela Octavia Popa; Ana Maria Irimia; Mihai Nicolae Papagheorghe; Elena Miruna Vasile; Simona Andreea Tircol; Raluca Andreea Negulescu; Catalina Toader; Robert Adam; Lucian Dorobantu; Cristina Caldararu; Maria Alexandrescu; Sebastian Onciul Journal: Discoveries (Craiova) Date: 2016-06-30