TY - JOUR
T1 - Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation
AU - Kwon, Deborah H.
AU - Smedira, Nicholas G.
AU - Thamilarasan, Maran
AU - Lytle, Bruce W.
AU - Lever, Harry
AU - Desai, Milind Y.
PY - 2010
Y1 - 2010
N2 - 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
AB - 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
KW - cardiac magnetic resonance
KW - CMR
KW - HCM
KW - hypertrophic cardiomyopathy
KW - left ventricular outflow tract
KW - LVOT
KW - SAM
KW - systolic anterior motion
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U2 - 10.1016/j.jtcvs.2009.10.045
DO - 10.1016/j.jtcvs.2009.10.045
M3 - Article
C2 - 20038476
AN - SCOPUS:77955468073
SN - 0022-5223
VL - 140
SP - 317
EP - 324
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -