Document Detail


Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients.
MedLine Citation:
PMID:  1169134     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The results of operative treatment in 83 patients with idiopathic hypertrophic subaortic stenosis (IHSS) are described. Most patients with the disease are asymptomatic, or derive satisfactory symptomatic improvement from nonoperative therapy: administration of propranolol, exerice limitation, control of arrhythmia, etc. Operation is required, however, in 10-15% of patients, those who remain severely symptomatic after nonoperative treatment or who become refractory to it. Operation relieves symptoms in IHSS by relieving obstruction to left ventricular outflow, and for a patient to be considered an operative candidate severe obstruction must be documented at left heart catheterization either under resting conditions or after provocative interventions. All 83 patients were severely incapacitated--58 in Class III and 24 in Class IV. Seventy had obstruction at rest (average gradient 96 mm Hg), and 13 had only provocable obstruction. At operation the hypertrophic interventricular septum was exposed via an aortotomy, and a vertical bar of muscle was resected between parallel myotomy incisions. There were six operative deaths (7%); no patient has died since 1970. Seven patients have died late after operation, five of them from causes unrelated to their heart disease or the operation. All surviving patients describe symptomatic improvement. Fifty-two patients with obstruction at rest preoperatively (average gradient 95 mm Hg) have been studied postoperatively: no resting gradient was evident in 47, while in the remaining five the gradient was less than 25 mm Hg. Recurrence of obstruction has never been observed at late catheterization (21 pts) or late echocardiographic examination (37 pts). Obstruction could not be provoked postoperatively in ten of the 11 patients who had large gradients only with the Valsalva maneuver or isoproterenol administration preoperatively. Obstructed and provocable obstructed patients had similar symptomatic improvement after operation. A variety of rhythm and conduction abnormalities were observed both pre and postoperatively, and these are described in detail. The results of operation in these 83 patients with IHSS demonstrate that gratifying symptomatic and hemodynamic improvement uniformly follows left ventriculomyotomy and myectomy. Relief of obstruction and amelioration of symptoms have proved to be long-lasting during postoperative observation periods extending to 14 years. Continued application of the operative procedure in properly selected patients appears to be indicated.
Authors:
A G Morrow; B A Reitz; S E Epstein; W L Henry; D M Conkle; S B Itscoitz; D R Redwood
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  52     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1975 Jul 
Date Detail:
Created Date:  1975-08-29     Completed Date:  1975-08-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  88-102     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aortic Stenosis, Subvalvular / diagnosis,  surgery*
Arrhythmias, Cardiac / diagnosis
Blood Pressure
Cardiomyopathy, Hypertrophic / surgery*
Child
Echocardiography
Electrocardiography
Female
Heart Catheterization
Heart Septum / surgery
Hemodynamics
Humans
Hypertrophy / surgery
Male
Middle Aged
Mitral Valve Insufficiency / diagnosis
Postoperative Complications / diagnosis
Remission, Spontaneous
Valsalva Maneuver

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


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