Document Detail


Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae.
MedLine Citation:
PMID:  14762358     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Transaortic left ventricular septal myectomy yields excellent results for most severely symptomatic patients with hypertrophic obstructive cardiomyopathy. However, associated anomalies of the mitral subvalvular apparatus may prevent complete relief of obstruction, and mitral valve replacement has been advocated. We reviewed our results of procedures designed to relieve obstruction with preservation of the mitral valve. METHODS: Among 291 patients undergoing septal myectomy from 1975 to 2002, 56 (ages 2-77 years) had anomalous mitral subvalvular apparatus including anomalous chordae (n = 28) and papillary muscles with direct insertion into mitral leaflets (n = 13) or fusion to septum (n = 31) or free wall (n = 12); 82% of patients were in New York Heart Association class III or IV. Operation included resection of anomalous chordae (28 patients), relief of papillary muscle fusion (36 patients), and extended septal myectomy, wider at the apex than the base. RESULTS: There were no early deaths and no patients required mitral valve replacement. Mean peak pressure gradients decreased from 70 +/- 28 to 4.9 +/- 8.4 mm Hg and mean mitral regurgitation grade decreased from 2.3 to 1.0 (P <.001). Mean follow-up was 2.8 +/- 2.6 years. Freedom from reoperation at 4 years was 95%. There were 3 late noncardiac deaths; 98% of patients were in New York Heart Association class I or II. CONCLUSIONS: Hypertrophic obstructive cardiomyopathy associated with anomalous mitral papillary muscles or chordae can be successfully treated without mitral valve replacement by surgical relief of the anomalies and an extended septal myectomy; early mortality is low, obstruction and mitral regurgitation are significantly reduced, and late results are excellent.
Authors:
Kenji Minakata; Joseph A Dearani; Rick A Nishimura; Barry J Maron; Gordon K Danielson
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  127     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-05     Completed Date:  2004-05-25     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  481-9     Citation Subset:  AIM; IM    
Affiliation:
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aortic Valve / pathology,  surgery,  ultrasonography
Cardiomyopathies / epidemiology,  therapy*
Cardiomyopathy, Hypertrophic / epidemiology,  therapy*
Cardiopulmonary Bypass
Child
Child, Preschool
Chordae Tendineae / pathology*,  surgery*
Cohort Studies
Defibrillators, Implantable
Echocardiography
Echocardiography, Transesophageal
Electrocardiography
Female
Follow-Up Studies
Heart Septum / pathology*,  surgery*
Humans
Male
Middle Aged
Minnesota / epidemiology
Mitral Valve / pathology*,  surgery*,  ultrasonography
Mitral Valve Insufficiency / epidemiology,  therapy*
Papillary Muscles / pathology*,  surgery*
Risk Factors
Severity of Illness Index
Stroke Volume / physiology
Survival Analysis
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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