Pathoanatomic Findings and Treatment During Hypertrophic Obstructive Cardiomyopathy Surgery: The Role of Mitral Valve

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Abstract

Background: To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles, PM) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM). Methods: Twenty-eight consecutive patients (58 ± 11 years, 53% female) undergoing HOCM surgery from 2007 to 2016 at our institute were retrospectively reviewed. Endpoints included the involvement of the mitral valve in LVOT obstruction, mortality, and changes in clinical and echocardiographic characteristics after HOCM surgery. Results: Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum, and systolic anterior motion were detected in 78% of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 50%, 25%, and 35% of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (92%), PM, and muscularis trabeculae resection (71%), and PM splitting and elongation (28%) were added variably to septal myectomy (100%). Nine procedures (32%) on mitral valve leaflets were performed, involving six posterior and three anterior mitral leaflets. Long-term follow-up was 4 ± 2.8 years. There was no hospital mortality, and NYHA was reduced from 3 ± 0.5 to 1 ± 0.7 (p < 0.0001), the LVOT gradient from 88 ± 35 to 20 ± 18 mmHg (p < 0.0001), mitral valve regurgitation from grade 3 ± 1 to 1 ± 0.7 (p < 0.0001), and septum thickness from 18 ± 3 to 14 ± 2 mm (p < 0.0001). Conclusions: The mitral valve apparatus contributes with all its components variably to LVOT dynamic obstruction thus surgical correction in addition to extended myectomy is recommended to achieve the best outcome.

Original languageEnglish
JournalHeart Lung and Circulation
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Hypertrophic Cardiomyopathy
Mitral Valve
Heart Ventricles
Chordae Tendineae
Papillary Muscles
Mitral Valve Insufficiency
Therapeutics
Hospital Mortality
Hypertrophy
Mortality

Keywords

  • Aortic approach
  • Extensive myectomy
  • Hypertrophic obstructive cardiomyopathy
  • Mitral approach
  • Mitral valve repair
  • Systolic anterior motion

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{4a5fe3b5873645b2bd6157c3d633c38a,
title = "Pathoanatomic Findings and Treatment During Hypertrophic Obstructive Cardiomyopathy Surgery: The Role of Mitral Valve",
abstract = "Background: To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles, PM) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM). Methods: Twenty-eight consecutive patients (58 ± 11 years, 53{\%} female) undergoing HOCM surgery from 2007 to 2016 at our institute were retrospectively reviewed. Endpoints included the involvement of the mitral valve in LVOT obstruction, mortality, and changes in clinical and echocardiographic characteristics after HOCM surgery. Results: Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum, and systolic anterior motion were detected in 78{\%} of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 50{\%}, 25{\%}, and 35{\%} of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (92{\%}), PM, and muscularis trabeculae resection (71{\%}), and PM splitting and elongation (28{\%}) were added variably to septal myectomy (100{\%}). Nine procedures (32{\%}) on mitral valve leaflets were performed, involving six posterior and three anterior mitral leaflets. Long-term follow-up was 4 ± 2.8 years. There was no hospital mortality, and NYHA was reduced from 3 ± 0.5 to 1 ± 0.7 (p < 0.0001), the LVOT gradient from 88 ± 35 to 20 ± 18 mmHg (p < 0.0001), mitral valve regurgitation from grade 3 ± 1 to 1 ± 0.7 (p < 0.0001), and septum thickness from 18 ± 3 to 14 ± 2 mm (p < 0.0001). Conclusions: The mitral valve apparatus contributes with all its components variably to LVOT dynamic obstruction thus surgical correction in addition to extended myectomy is recommended to achieve the best outcome.",
keywords = "Aortic approach, Extensive myectomy, Hypertrophic obstructive cardiomyopathy, Mitral approach, Mitral valve repair, Systolic anterior motion",
author = "Raffa, {Giuseppe M.} and Giuseppe Romano and Marco Turrisi and Marco Morsolini and Giovanni Gentile and Sergio Sciacca and Alessandro Armaro and Vincenzo Stringi and Gabriella Mattiucci and Serena Magro and Fabiola Cosentino and Francesco Clemenza and Michele Pilato",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.hlc.2018.02.006",
language = "English",
journal = "Heart Lung and Circulation",
issn = "1443-9506",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Pathoanatomic Findings and Treatment During Hypertrophic Obstructive Cardiomyopathy Surgery

T2 - The Role of Mitral Valve

AU - Raffa, Giuseppe M.

AU - Romano, Giuseppe

AU - Turrisi, Marco

AU - Morsolini, Marco

AU - Gentile, Giovanni

AU - Sciacca, Sergio

AU - Armaro, Alessandro

AU - Stringi, Vincenzo

AU - Mattiucci, Gabriella

AU - Magro, Serena

AU - Cosentino, Fabiola

AU - Clemenza, Francesco

AU - Pilato, Michele

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles, PM) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM). Methods: Twenty-eight consecutive patients (58 ± 11 years, 53% female) undergoing HOCM surgery from 2007 to 2016 at our institute were retrospectively reviewed. Endpoints included the involvement of the mitral valve in LVOT obstruction, mortality, and changes in clinical and echocardiographic characteristics after HOCM surgery. Results: Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum, and systolic anterior motion were detected in 78% of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 50%, 25%, and 35% of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (92%), PM, and muscularis trabeculae resection (71%), and PM splitting and elongation (28%) were added variably to septal myectomy (100%). Nine procedures (32%) on mitral valve leaflets were performed, involving six posterior and three anterior mitral leaflets. Long-term follow-up was 4 ± 2.8 years. There was no hospital mortality, and NYHA was reduced from 3 ± 0.5 to 1 ± 0.7 (p < 0.0001), the LVOT gradient from 88 ± 35 to 20 ± 18 mmHg (p < 0.0001), mitral valve regurgitation from grade 3 ± 1 to 1 ± 0.7 (p < 0.0001), and septum thickness from 18 ± 3 to 14 ± 2 mm (p < 0.0001). Conclusions: The mitral valve apparatus contributes with all its components variably to LVOT dynamic obstruction thus surgical correction in addition to extended myectomy is recommended to achieve the best outcome.

AB - Background: To assess the role of the mitral valve apparatus (leaflets, chordae and papillary muscles, PM) in left ventricle outflow tract (LVOT) obstruction, and results of the surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM). Methods: Twenty-eight consecutive patients (58 ± 11 years, 53% female) undergoing HOCM surgery from 2007 to 2016 at our institute were retrospectively reviewed. Endpoints included the involvement of the mitral valve in LVOT obstruction, mortality, and changes in clinical and echocardiographic characteristics after HOCM surgery. Results: Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum, and systolic anterior motion were detected in 78% of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were found in 50%, 25%, and 35% of the patients, respectively. Four patients had posterior leaflet redundancy. Secondary chordae (92%), PM, and muscularis trabeculae resection (71%), and PM splitting and elongation (28%) were added variably to septal myectomy (100%). Nine procedures (32%) on mitral valve leaflets were performed, involving six posterior and three anterior mitral leaflets. Long-term follow-up was 4 ± 2.8 years. There was no hospital mortality, and NYHA was reduced from 3 ± 0.5 to 1 ± 0.7 (p < 0.0001), the LVOT gradient from 88 ± 35 to 20 ± 18 mmHg (p < 0.0001), mitral valve regurgitation from grade 3 ± 1 to 1 ± 0.7 (p < 0.0001), and septum thickness from 18 ± 3 to 14 ± 2 mm (p < 0.0001). Conclusions: The mitral valve apparatus contributes with all its components variably to LVOT dynamic obstruction thus surgical correction in addition to extended myectomy is recommended to achieve the best outcome.

KW - Aortic approach

KW - Extensive myectomy

KW - Hypertrophic obstructive cardiomyopathy

KW - Mitral approach

KW - Mitral valve repair

KW - Systolic anterior motion

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U2 - 10.1016/j.hlc.2018.02.006

DO - 10.1016/j.hlc.2018.02.006

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AN - SCOPUS:85044858887

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

SN - 1443-9506

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