Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation

Deborah H. Kwon, Nicholas G. Smedira, Maran Thamilarasan, Bruce W. Lytle, Harry Lever, Milind Y. Desai

Research output: Contribution to journalArticle

Abstract

Objective: In patients with hypertrophic cardiomyopathy with bifid hypermobile papillary muscles and a dynamic left ventricular outflow tract gradient, we performed surgical papillary muscle reorientation, fixing the mobile papillary muscle to the posterior left ventricle to reduce mobility. We report the outcomes of patients with hypertrophic cardiomyopathy undergoing surgical papillary muscle reorientation versus those of patients undergoing standard surgical procedures. Methods: We studied 204 consecutive patients with hypertrophic cardiomyopathy undergoing surgical intervention (after consensus decision) for symptomatic left ventricular outflow tract gradient. Preoperative and postoperative maximal (resting/provocable) left ventricular outflow tract gradients were recorded by using echocardiographic analysis. Results: The population was divided into 3 groups: (1) isolated myectomy (n = 143; age, 54 ± 14 years; 48% men), (2) myectomy plus mitral valve repair/replacement (n = 39; age, 54 ± 13 years; 54% men), and (3) papillary muscle reorientation with or without myectomy (n = 22; age, 50 ± 14 years; 59% men). The mean preoperative (103 ± 32, 103 ± 32, and 114 ± 36 mm Hg; P = .3) and predischarge (15 ± 18, 14 ± 14, and 16 ± 21 mm Hg; P = .9) maximal left ventricular outflow tract gradients were similar. There were no deaths either in the hospital or at 30 days. At a median follow-up of 166 days (interquartile range, 74-343 days), 21 of 22 patients in group 3 were asymptomatic. One patient in group 3 had a symptomatic left ventricular outflow tract gradient (87 mm Hg) requiring mitral valve replacement. Conclusions: In patients with hypertrophic cardiomyopathy with bifid hypermobile papillary muscles (even with a basal septal thickness

Original languageEnglish (US)
Pages (from-to)317-324
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume140
Issue number2
DOIs
StatePublished - 2010
Externally publishedYes

Keywords

  • cardiac magnetic resonance
  • CMR
  • HCM
  • hypertrophic cardiomyopathy
  • left ventricular outflow tract
  • LVOT
  • SAM
  • systolic anterior motion

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Fingerprint Dive into the research topics of 'Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation'. Together they form a unique fingerprint.

  • Cite this