|Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae.|
|PMID: 14762358 Owner: NLM Status: MEDLINE|
|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.|
|Kenji Minakata; Joseph A Dearani; Rick A Nishimura; Barry J Maron; Gordon K Danielson|
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|Type: Evaluation Studies; Journal Article|
|Title: The Journal of thoracic and cardiovascular surgery Volume: 127 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2004 Feb|
|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|
|Languages: eng Pagination: 481-9 Citation Subset: AIM; IM|
|Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn, USA.|
|APA/MLA Format Download EndNote Download BibTex|
Aged, 80 and over
Aortic Valve / pathology, surgery, ultrasonography
Cardiomyopathies / epidemiology, therapy*
Cardiomyopathy, Hypertrophic / epidemiology, therapy*
Chordae Tendineae / pathology*, surgery*
Heart Septum / pathology*, surgery*
Minnesota / epidemiology
Mitral Valve / pathology*, surgery*, ultrasonography
Mitral Valve Insufficiency / epidemiology, therapy*
Papillary Muscles / pathology*, surgery*
Severity of Illness Index
Stroke Volume / physiology
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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