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- Title
Surgical correction of hypertrophic obstructive cardiomyopathy in patients with simultaneous obstruction of left ventricular midcavity and right ventricular outflow tract†.
- Authors
Borisov, Konstantin Valentinovitch
- Abstract
OBJECTIVE The classic Morrow technique for hypertrophic obstructive cardiomyopathy (HOCM) in patients with simultaneous obstruction of left ventricular (LV) midcavity and right ventricular outflow tract (RVOT) combined with extreme left ventricular hypertrophy, is not effective. A new technique for HOCM surgical correction in patients with severe hypertrophy is proposed. METHODS The excision of the asymmetrical hypertrophied area of the interventricular septum (IVS) causing simultaneous midventricular and RVOT obstruction was performed from the conal part of the right ventricle (RV) in the middle part of the right side of the IVS. Conceptually, this approach offers a number of advantages: it affords the excision of the asymmetrically hypertrophied area of the ventricular septum without penetration into the left ventricular cavity, it avoids mechanical damage to the heart conduction system and aortic valve and, for the surgeon, it improves the visual inspection of the area to be resected. Seven patients with the midventricular obstruction of the LV associated with RVOT obstruction [mean New York Heart Association (NYHA) class 3.0] underwent this procedure. The follow-up period was 24.8 ± 11.3 months. RESULTS Six patients were free of symptoms (NYHA class I) and one was in NYHA class 2. There were no early or late deaths. The mean value of the echocardiographic intraventricular gradients in the LV decreased from 86.3 ± 9.9 to 10.3 ± 5.3 mmHg, the mean value of the gradients in the RVOT decreased to 44.9 ± 9.6 versus 4.1 ± 1.2 mmHg. Sinus rhythm without the block of the bundle of the right branch was noted in all patients after surgery. No patients needed the implantation of a cardioverter-defibrillator. CONCLUSION This technique for the surgical correction of HOCM provides the effective simultaneous elimination of LV midventricular and RVOT obstruction. A major advantage is that injuries, in particular to the conduction system, are easily avoided.
- Subjects
NEW York (N.Y.); HYPERTROPHIC cardiomyopathy; VENTRICULAR outflow obstruction; SURGICAL count procedure; STRESS echocardiography; SURGICAL &; topographical anatomy; NEW York Heart Association
- Publication
European Journal of Cardio-Thoracic Surgery, 2013, Vol 43, Issue 1, p67
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezs172