Surgical Strategies for Hypertrophic Obstructive Cardiomyopathy （HOCM) with Severe Mitral Valve Regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

DINGShi-ao ,  MEIJu , DINGFang-bao , LIUHao , BAOChun-rong , TANGMin , JIANGZhao-lei , SHENSai-e , WUShu-bin

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding?author：

MEIJu, Email: ju_mei63@126.com

Keywords：

hypertrophic obstructive cardiomyopathy (HOCM); Left ventricular outflow tract obstruction; Mitral regurgitation; Mitral valve repair; Extended myectomy

DOI：

10.7507/1007-4848.20160162

Video：

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Objective To summarize the surgical treatment strategies and the clinical outcomes of hypertrophic obstructive cardiomyopathy (HOCM) with severe mitral regurgitation. Method We retrospectively analyzed the clinical data of 23 patients of HOCM with severe mitral regurgitation in our hospital from January 2004 through January 2014 year. There were 14 males and 9 females, aged from 15-71(50.2±15.4) years. The preoperative left ventricular outflow tract gradient (LVOTPG) of these patients was 75-161(98.1±19.3) mm Hg. And the septal thickness was 25.8±2.8 mm. All 23 patients had at least moderate mitral regurgitation and systolic anterior motion (SAM). All of them had extend septal myectomy (extend Marrow procedure) and mitral valve repair(MVP),while 4 patients with atrial fibrillation had left atrial ablation and left atrial appendage operation. Results All patients were successfully operated. The left ventricular outflow tract pressure gradient was 16-39(26.9±4.9) mm Hg when the cardiopulmonary bypass stopped and SAM phenomenon was completely eliminated. Except for 2 mitral valve patients with trace amounts of regurgitation, 1 patient with mild regurgitation, the other 20 patients of mitral regurgitation were completely corrected. All patients survived after operation and only 1 patient suffered from transient complete atrioventricular block and then back to normal sinus rhythm. A long-term follow-up from 6 months to 126 months with an average of 53.1±34.9 months showed no late postoperative death. No mitral regurgitation need reoperation. Two patients had mild reflux. Four patients were of trace reflux. The left ventricular outflow tract the maximum pressure gradient was less than 42 mm Hg. The thickness of interventricular septum dropped from preoperative 25.8±2.8 mm to postoperative 14.1±1.3 mm (P<0.001) . No recurrence was noted in the 3 patients with atrial fibrillation. And one patient still had paroxysmal atrial fibrillation. Long term follow-up of the patients' symptoms disappeared or with only mild symptoms. And quality of their life improved significantly. And there was no long-term complication, reoperation, or death. Conclusions The extensive septal myectomy can completely dredge left ventricular outflow tract stenosis and eliminate SAM phenomenon. The mitral valve repair can correct mitral regurgitation. The comprehensive surgical treatment strategy can achieve a good long-term therapeutic effect.

Citation： DINGShi-ao, MEIJu, DINGFang-bao, LIUHao, BAOChun-rong, TANGMin, JIANGZhao-lei, SHENSai-e, WUShu-bin. Surgical Strategies for Hypertrophic Obstructive Cardiomyopathy （HOCM) with Severe Mitral Valve Regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(7): 675-678. doi: 10.7507/1007-4848.20160162 Copy

1.	Wang Y, Liu G, Wang G, et al. extended myectomy for hypertrophic obstructive cardiomyopathy. Heart Surg Forum, 2012, 15(5) :E251-E256.
2.	羅明堯, 王水云, 宋云虎, 等. 118例肥厚型梗阻性心肌病的外科治療經驗. 中華醫學雜志, 2013, 9(2) :110-113.
3.	Kwon DH, Smedira NG, Thamilarasan M, et al. 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(2) :317-324.
4.	Hensley N, Dietrich J, Nyhan D, et al. Hypertrophic cardiomyopathy:a review. Anesth Analg, 2015, 120(3) :554-569.
5.	Swistel D G, Balaram SK. Surgical myectomy for hypertrophic cardiomyopathy in the 21st century, the evolution of the "RPR" repair:resection, plication, and release. Prog Cardiovascr Dis, 2012, 54(6) :498-502.
6.	Wan CKN, Dearani JA, Sundt TM, et al. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation? Ann Thorac Surg, 2009, 88(3) :727-732.
7.	楊建國, 陶涼, 陳緒發, 等. 外科治療肥厚型梗阻性心肌病的近中期療效評價. 中國胸心血管外科臨床雜志, 2015, 22(9) :837-840.
8.	宋躍, 宋邦榮, 曹劍, 等. 改良Morrow 手術治療肥厚型梗阻性心肌病的療效分析. 中國胸心血管外科臨床雜志, 2014, 21(3) :348-351.
9.	Nakamura T, Sekiya N, Nakazato T, et al. Systolic anterior motion of the mitral valve masked by general anesthesia. Asian Cardiovasc Thorac Ann, 2013, 22(2) :197-199.
10.	Gutermann H, Pettinari M, Van Kerrebroeck C, et al. Myectomy and mitral repair through the left atrium in hypertrophic obstructive cardiomyopathy:The preferred approach for contemporary surgical candidates? J Thorac Cardiovascr Surg, 2014, 147(6) :1833-1836.
11.	Balaram SK, Ross RE, Sherrid MV, et al. Role of mitral valve plica-tion in the surgical management of hypertrophic cardiomyopathy. Ann Thorac Surg, 2012, 94(6) :1990-1998.
12.	Matsui Y, Shiiya N, Murashita T, et al. Mitral valve repair and septal myectomy for hypertrophic obstructive cardiomyopathy. J Cardiovasc Surg (Torino), 2000, 41(1) :53-56.
13.	鄭鐵, 孟旭, 王堅剛, 等. 外科手術治療肥厚梗阻型心肌病. 中華胸心血管外科雜志, 2006, 22(2) :133.
14.	Delmo Walter EMB, Siniawski H, Hetzer R. Sustained improvement after combined anterior mitral valve leaflet retention plasty and septal myectomy in preventing systolic anterior motion in hyper-trophic obstructive cardiomyopathy in children. Eur J Cardio-Thoracic Surg, 2009, 36(3) :546-552.
15.	Wang S, Luo M, Sun H, et al. A retrospective clinical study of transaortic extended septal myectomy for obstructive hypertrophic cardiomyopathy in China. Eur J Cardio-Thorac Surg, 2012, 43(3) :534-540.
16.	Geske JB, Konecny T, Ommen SR, et al. Surgical myectomy improves pulmonary hypertension in obstructive hypertrophic cardiomyopathy. Eur Heart J, 2013, 35(30) :2032-2039.

1. Wang Y, Liu G, Wang G, et al. extended myectomy for hypertrophic obstructive cardiomyopathy. Heart Surg Forum, 2012, 15(5) :E251-E256.
2. 羅明堯, 王水云, 宋云虎, 等. 118例肥厚型梗阻性心肌病的外科治療經驗. 中華醫學雜志, 2013, 9(2) :110-113.
3. Kwon DH, Smedira NG, Thamilarasan M, et al. 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(2) :317-324.
4. Hensley N, Dietrich J, Nyhan D, et al. Hypertrophic cardiomyopathy:a review. Anesth Analg, 2015, 120(3) :554-569.
5. Swistel D G, Balaram SK. Surgical myectomy for hypertrophic cardiomyopathy in the 21st century, the evolution of the "RPR" repair:resection, plication, and release. Prog Cardiovascr Dis, 2012, 54(6) :498-502.
6. Wan CKN, Dearani JA, Sundt TM, et al. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation? Ann Thorac Surg, 2009, 88(3) :727-732.
7. 楊建國, 陶涼, 陳緒發, 等. 外科治療肥厚型梗阻性心肌病的近中期療效評價. 中國胸心血管外科臨床雜志, 2015, 22(9) :837-840.
8. 宋躍, 宋邦榮, 曹劍, 等. 改良Morrow 手術治療肥厚型梗阻性心肌病的療效分析. 中國胸心血管外科臨床雜志, 2014, 21(3) :348-351.
9. Nakamura T, Sekiya N, Nakazato T, et al. Systolic anterior motion of the mitral valve masked by general anesthesia. Asian Cardiovasc Thorac Ann, 2013, 22(2) :197-199.
10. Gutermann H, Pettinari M, Van Kerrebroeck C, et al. Myectomy and mitral repair through the left atrium in hypertrophic obstructive cardiomyopathy:The preferred approach for contemporary surgical candidates? J Thorac Cardiovascr Surg, 2014, 147(6) :1833-1836.
11. Balaram SK, Ross RE, Sherrid MV, et al. Role of mitral valve plica-tion in the surgical management of hypertrophic cardiomyopathy. Ann Thorac Surg, 2012, 94(6) :1990-1998.
12. Matsui Y, Shiiya N, Murashita T, et al. Mitral valve repair and septal myectomy for hypertrophic obstructive cardiomyopathy. J Cardiovasc Surg (Torino), 2000, 41(1) :53-56.
13. 鄭鐵, 孟旭, 王堅剛, 等. 外科手術治療肥厚梗阻型心肌病. 中華胸心血管外科雜志, 2006, 22(2) :133.
14. Delmo Walter EMB, Siniawski H, Hetzer R. Sustained improvement after combined anterior mitral valve leaflet retention plasty and septal myectomy in preventing systolic anterior motion in hyper-trophic obstructive cardiomyopathy in children. Eur J Cardio-Thoracic Surg, 2009, 36(3) :546-552.
15. Wang S, Luo M, Sun H, et al. A retrospective clinical study of transaortic extended septal myectomy for obstructive hypertrophic cardiomyopathy in China. Eur J Cardio-Thorac Surg, 2012, 43(3) :534-540.
16. Geske JB, Konecny T, Ommen SR, et al. Surgical myectomy improves pulmonary hypertension in obstructive hypertrophic cardiomyopathy. Eur Heart J, 2013, 35(30) :2032-2039.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Strategies for Hypertrophic Obstructive Cardiomyopathy （HOCM) with Severe Mitral Valve Regurgitation

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