Clinical Outcomes of Modified Morrow Procedure for the Treatment of Hypertrophic Obstructive Cardiomyopathy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SONGYue ,  SONGBang-rong , CAOJian , ZHANGKui

Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, P. R. China;

Corresponding author：

SONGBang-rong, Email: sbran8899@sina.com

Keywords：

Hypertrophic obstructive cardiomyopathy; Morrow procedure; Modified Morrow procedure

DOI：

10.7507/1007-4848.20140095

Video：

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Objective To compare clinical outcomes between modified and traditional Morrow procedures for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Methods Forty-two HOCM patients undergoing surgical correction in Beijing Anzhen Hospital between January 2005 and July 2011 were recruited in this study. According to different surgical techniques, all the patients were divided into 2 groups. In traditional Morrow procedure group, there were 16 patients including 13 males and 3 females with their age of 49±15 years. In modified Morrow procedure group, there were 26 patients including 14 males and 12 females with their age of 40±18 years. Preoperative and postoperative echocardiography were performed to compare ventricular septal thickness (VST), left ventricular outflow tract velocity (LVOTV)and left ventricular outflow gradient (LVOG)between the 2 groups. Results VST, LVOTV and LVOG of HOCM patients were significantly reduced after both traditional and modified Morrow procedure. There was statistical difference in preoperative and postoperative VST (23.10±3.64 mm vs. 17.38±4.39 mm), LVOTV (433.08±101.68 mm/s vs. 248.46±101.88 mm/s)and LVOG (78.57±40.16 mm Hg vs. 4.29±21.52 mm Hg)in traditional Morrow procedure group (P < 0.05). There was statistical difference in preoperative and postoperative VST (25.04±47.05 mm vs. 18.38±6.55 mm, P < 0.05), LVOTV (414.83±83.33 mm/s vs. 159.72±60.84 mm/s, P < 0.05)and LVOG (77.94±29.16 mm Hg vs. 17.56±9.39 mm Hg, P < 0.05)in modified Morrow procedure group (P < 0.05). Preoperative and postoperative difference in LVOG of modified Morrow procedure group was more significant than that of traditional Morrow procedure group (74.25±27.91 mm Hg vs. 34.63±30.66 mm Hg, P < 0.05). Conclusion Modified Morrow procedure is superior to traditional Morrow procedure in reducing postoperative LVOG for HOCM patients.

Citation： SONGYue, SONGBang-rong, CAOJian, ZHANGKui. Clinical Outcomes of Modified Morrow Procedure for the Treatment of Hypertrophic Obstructive Cardiomyopathy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(3): 348-351. doi: 10.7507/1007-4848.20140095 Copy

1.	Maron MS, Olivotto I, Zenovich AG, et al. Hypertrophic cardiomyo-pathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation, 2006, 114 (21):2232-2239.
2.	Case RB, Morrow AG, Stainsby W, et al. Anomalous origin of the left coronary artery; the physiologic defect and suggested surgical treatment. Circulation, 1958, 17 (6):1062-1068.
3.	Marian AJ. Contemporary treatment of hypertrophic cardiomyopathy. Tex Heart Inst J, 2009, 36 (3):194-204.
4.	Ommen SR, Maron BJ, Olivotto I, et al. Long-term effects of surg-ical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol, 2005, 46 (3):470-476.
5.	Morrow AG, Reitz BA, Epstein SE, et al. Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation, 1975, 52 (1):88-102.
6.	Minakata K, Dearani JA, Nishimura RA, et al. Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae. J Thorac Cardiovasc Surg, 2004, 127 (2):481-489.
7.	Maron BJ, Dearani JA, Ommen SR, et al. The case for surgery in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol, 2004, 44 (10):2044-2053.
8.	Ryan LP, Jackson BM, Parish LM, et al. Mitral valve tenting index for assessment of subvalvular remodeling. Ann Thorac Surg, 2007, 84 (4):1243-1249.
9.	Maron BJ. Controversies in cardiovascular medicine. Surgical myectomy remains the primary treatment option for severely symptomatic patients with obstructive hypertrophic cardiomyopathy. Circulation, 2007, 116 (2):196-206.
10.	Maron BJ, Estes NR, Maron MS, et al. Primary prevention of sudden death as a novel treatment strategy in hypertrophic cardiomyopathy. Circulation, 2003, 107 (23):2872-2875.
11.	Ibrahim M, Rao C, Ashrafian H, et al. Modern management of systolic anterior motion of the mitral valve. Eur J Cardiothorac Surg, 2012, 41 (6):1260-1270.
12.	Cooley DA. Surgical techniques for hypertrophic left ventricular obstructive myopathy including mitral valve plication. J Card Surg, 1991, 6 (1):29-33.
13.	Sherrid MV, Chaudhry FA, Swistel DG. Obstructive hypertrophic cardiomyopathy:echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. Ann Thorac Surg, 2003, 75 (2):620-632.
14.	Jezyk D, Duda B, Jerzemowski J, et al. Positions of septal papillary muscles in human hearts. Folia Morphol (Warsz), 2010, 69 (2):101-106.
15.	Rao N, Gajjar T, Desai N. Accessory mitral valve tissue:an unusual cause of congenital mitral stenosis. Interact Cardiovasc Thorac Surg, 2012, 14 (1):110-112.
16.	Klues HG, Maron BJ, Dollar AL, et al. Diversity of structural mitral valve alterations in hypertrophic cardiomyopathy. Circulation, 1992, 85 (5):1651-1660.
17.	Vogel-Claussen J, Finn JP, Gomes AS, et al. Left ventricular papillary muscle mass:relationship to left ventricular mass and volumes by magnetic resonance imaging. J Comput Assist Tomogr, 2006, 30 (3):426-432.
18.	Smedira NG, Lytle BW, Lever HM, et al. Current effectiveness and risks of isolated septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg, 2008, 85 (1):127-133.

1. Maron MS, Olivotto I, Zenovich AG, et al. Hypertrophic cardiomyo-pathy is predominantly a disease of left ventricular outflow tract obstruction. Circulation, 2006, 114 (21):2232-2239.
2. Case RB, Morrow AG, Stainsby W, et al. Anomalous origin of the left coronary artery; the physiologic defect and suggested surgical treatment. Circulation, 1958, 17 (6):1062-1068.
3. Marian AJ. Contemporary treatment of hypertrophic cardiomyopathy. Tex Heart Inst J, 2009, 36 (3):194-204.
4. Ommen SR, Maron BJ, Olivotto I, et al. Long-term effects of surg-ical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol, 2005, 46 (3):470-476.
5. Morrow AG, Reitz BA, Epstein SE, et al. Operative treatment in hypertrophic subaortic stenosis. Techniques, and the results of pre and postoperative assessments in 83 patients. Circulation, 1975, 52 (1):88-102.
6. Minakata K, Dearani JA, Nishimura RA, et al. Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae. J Thorac Cardiovasc Surg, 2004, 127 (2):481-489.
7. Maron BJ, Dearani JA, Ommen SR, et al. The case for surgery in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol, 2004, 44 (10):2044-2053.
8. Ryan LP, Jackson BM, Parish LM, et al. Mitral valve tenting index for assessment of subvalvular remodeling. Ann Thorac Surg, 2007, 84 (4):1243-1249.
9. Maron BJ. Controversies in cardiovascular medicine. Surgical myectomy remains the primary treatment option for severely symptomatic patients with obstructive hypertrophic cardiomyopathy. Circulation, 2007, 116 (2):196-206.
10. Maron BJ, Estes NR, Maron MS, et al. Primary prevention of sudden death as a novel treatment strategy in hypertrophic cardiomyopathy. Circulation, 2003, 107 (23):2872-2875.
11. Ibrahim M, Rao C, Ashrafian H, et al. Modern management of systolic anterior motion of the mitral valve. Eur J Cardiothorac Surg, 2012, 41 (6):1260-1270.
12. Cooley DA. Surgical techniques for hypertrophic left ventricular obstructive myopathy including mitral valve plication. J Card Surg, 1991, 6 (1):29-33.
13. Sherrid MV, Chaudhry FA, Swistel DG. Obstructive hypertrophic cardiomyopathy:echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. Ann Thorac Surg, 2003, 75 (2):620-632.
14. Jezyk D, Duda B, Jerzemowski J, et al. Positions of septal papillary muscles in human hearts. Folia Morphol (Warsz), 2010, 69 (2):101-106.
15. Rao N, Gajjar T, Desai N. Accessory mitral valve tissue:an unusual cause of congenital mitral stenosis. Interact Cardiovasc Thorac Surg, 2012, 14 (1):110-112.
16. Klues HG, Maron BJ, Dollar AL, et al. Diversity of structural mitral valve alterations in hypertrophic cardiomyopathy. Circulation, 1992, 85 (5):1651-1660.
17. Vogel-Claussen J, Finn JP, Gomes AS, et al. Left ventricular papillary muscle mass:relationship to left ventricular mass and volumes by magnetic resonance imaging. J Comput Assist Tomogr, 2006, 30 (3):426-432.
18. Smedira NG, Lytle BW, Lever HM, et al. Current effectiveness and risks of isolated septal myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg, 2008, 85 (1):127-133.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Outcomes of Modified Morrow Procedure for the Treatment of Hypertrophic Obstructive Cardiomyopathy

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