| Impact of septal myectomy on left atrial volume and left ventricular diastolic filling patterns: an echocardiographic study of young patients with obstructive hypertrophic cardiomyopathy. | |
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MedLine Citation:
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PMID: 18187287 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Septal myectomy in young patients with obstructive hypertrophic cardiomyopathy (HCM) can be performed with low mortality, and leads to excellent improvement in symptoms. Left atrial (LA) enlargement has been associated with exercise intolerance, severity of mitral regurgitation (MR), and left ventricular (LV) outflow tract (LVOT) obstruction in adults with HCM. METHODS: Young patients (1-22 years of age) who had a septal myectomy for obstructive HCM between 2002 and 2005 were identified. Retrospective analyses of premyectomy and postmyectomy echocardiograms were performed. RESULTS: In this cohort of 32 patients (25 male), the average maximal LV wall thickness was 25 +/- 9 mm and LVOT maximal instantaneous gradient was 106 +/- 44 mm Hg. MR was present in all patients with a mean grade of 3 +/- 1. All patients had successful myectomy and there were no early deaths. After myectomy, LVOT maximal instantaneous gradient decreased to 17 +/- 13 mm Hg (P < .0001). Mean LA volume (LAV) index decreased from 52.1 +/- 2.2 to 33.2 +/- 11.9 mL/m(2) (P < .0001). Mean MR grade decreased to 2 +/- 1. Early mitral medial annular tissue Doppler velocity (E') increased from 6.2 +/- 1.9 to 13 +/- 2.6 cm/s (P < .043). A postmyectomy decrease in LAV index correlated with decrease in LVOT obstruction (P = .001) and change in degree of MR (P = .04). CONCLUSION: Septal myectomy not only reduces LVOT maximal instantaneous gradient and MR in young patients, but also results in decreased LAV index, and E/A and E/E' ratios. These hemodynamic improvements may contribute to the observed survival benefit and increased exercise tolerance observed after myectomy. This is the first series to demonstrate that LAV correlates closely with hemodynamic status in children with obstructive HCM and may be a significant predictor of clinical outcome in these patients. |
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Authors:
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Shaji C Menon; Michael J Ackerman; Steve R Ommen; Allison K Cabalka; Donald J Hagler; Patrick W O'Leary; Joseph A Dearani; Frank Cetta; Benjamin W Eidem |
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Publication Detail:
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Type: Journal Article Date: 2008-01-09 |
Journal Detail:
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Title: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Volume: 21 ISSN: 1097-6795 ISO Abbreviation: J Am Soc Echocardiogr Publication Date: 2008 Jun |
Date Detail:
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Created Date: 2008-06-02 Completed Date: 2008-09-25 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8801388 Medline TA: J Am Soc Echocardiogr Country: United States |
Other Details:
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Languages: eng Pagination: 684-8 Citation Subset: IM |
Affiliation:
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Departments of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota 55905, USA. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Age Factors Cardiomyopathy, Hypertrophic / physiopathology, surgery, ultrasonography* Child Child, Preschool Diastole Female Heart Atria / physiopathology, ultrasonography* Heart Septum / physiopathology, surgery* Heart Ventricles / physiopathology, ultrasonography* Humans Infant Male Predictive Value of Tests Retrospective Studies Time Factors Ventricular Dysfunction, Left / physiopathology, ultrasonography |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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