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Septal Myectomy and Concomitant Left Ventricular Outflow Tract Intervention for Obstructive Hypertrophic Cardiomyopathy

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posted on 2022-03-29, 19:41 authored by Eduard Quintana

Septal myectomy for obstructive hypertrophic cardiomyopathy is a challenging operation. The ultimate goal is to achieve abolition of the obstruction and restore mitral valve competence. For many patients, surgical septal myectomy alone leads to this desired outcome. However, in some patients there may be associated abnormalities that pose risk for incomplete obstruction resolution. This video discusses several concomitant interventions at different levels of the left ventricular cavity and mitral valve apparatus. Judgmental use of such adjunct procedures may lead to full resolution of obstruction and preservation of the mitral valve. All these concomitant interventions can be performed through the same aortotomy, simplifying and expediting the operation.


References


- Affronti, A.; Pruna-Guillen, R.; Sandoval, E.; Pereda, D.; Alcocer, J.; Castellà, M.; Quintana, E. Surgery for Hypertrophic Obstructive Cardiomyopathy: Comprehensive LVOT Management Beyond Septal Myectomy. J. Clin. Med. 2021, 10, 4397.

- Balaram, S.K.; Ross, R.E.; Sherrid, M.; Schwartz, G.S.; Hillel, Z.; Winson, G.; Swistel, D.G. Role of Mitral Valve Plication in the Surgical Management of Hypertrophic Cardiomyopathy. Ann. Thorac. Surg. 2012, 94, 1990–1998,

doi:10.1016/j.athoracsur.2012.06.008.

- Klues, H.G.; Roberts, W.C.; Maron, B.J. Anomalous insertion of papillary muscle directly into anterior mitral leaflet in

hypertrophic cardiomyopathy. Significance in producing left ventricular outflow obstruction. Circulation 1991, 84, 1188–1197.

- Sherrid, M.V.; Männer, J.; Swistel, D.G.; Olivotto, I.; Halpern, D.G. On the Cardiac Loop and Its Failing: Left Ventricular Outflow

Tract Obstruction. J. Am. Heart Assoc. 2020, 9, e014857

- Schaff, H.V.; Said, S.M. Transaortic Extended Septal Myectomy for Hypertrophic Cardiomyopathy. Oper. Tech. Thorac.

Cardiovasc. Surg. 2012, 17, 238–250

- Sherrid, M.V.; Adams, D.H. The Mitral Valve in Hypertrophic Cardiomyopathy: Other Side of the Outflow Tract. J. Am. Coll.

Cardiol. 2020, 10, 2248–2251.

- Messmer, B.J. Extended myectomy for hypertrophic obstructive cardiomyopathy. Ann. Thorac. Surg. 1994, 58, 575–577.

- Minakata, K.; Dearani, J.A.; Nishimura, R.A.; Maron, B.J.; Danielson, G.K. Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae. J. Thorac. Cardiovasc. Surg. 2004, 127, 481–489.

- Swistel, D.G.; Sherrid, M.V. The surgical management of obstructive hypertrophic cardiomyopathy: The RPR procedure- resection, plication, release. Ann. Cardiothorac. Surg. 2017, 6, 423–425.

- Kwon, D.H.; Setser, R.M.; Thamilarasan, M.; Popovic, Z.V.; Smedira, N.G.; Schoenhagen, P.; Garcia, M.J.; Lever, H.M.; Desai,

M.Y. Abnormal papillary muscle morphology is independently associated with increased left ventricular outflow tract

obstruction in hypertrophic cardiomyopathy. Heart 2008, 94, 1295–1301.

- Kwon, D.H.; Smedira, N.G.; Thamilarasan, M.; Lytle, B.W.; Lever, H.; Desai, M.Y. Characteristics and surgical outcomes of

symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary

muscle reorientation. J. Thorac. Cardiovasc. Surg. 2010, 140, 317–324.

- Ferrazzi, P.; Spirito, P.; Iacovoni, A.; Calabrese, A.; Migliorati, K.; Simon, C.; Pentiricci, S.; Poggio, D.; Grillo, M.; Amigoni, P.; et al. Transaortic Chordal Cutting Mitral Valve Repair for Obstructive Hypertrophic Cardiomyopathy With Mild Septal

Hypertrophy. J. Am. Coll. Cardiol. 2015, 66, 1687–1696.

- Hodges, K.; Rivas, C.G.; Aguilera, J.; Borden, R.; Alashi, A.; Blackstone, E.H.; Desai, M.Y.; Smedira, N.G. Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center. J. Thorac. Cardio- vasc. Surg. 2019, 157, 2289–2299.


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