Surgical Treatment of Mitral Desease Patients Associated with Hypertrophic Obstructive Cardiomyopathy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KANGkai , CAIJun , JIAZhi-bo , ZHANGYu-nan , ZHANGChun-feng , ZHUZhi-tao , XIEBao-dong , JIANGShu-lin ,  TIANHai

Department of Cardiovascular Surgery, the 2nd Affiliated Hospital, Key Laboratory of Myocardial Ischemia Mechanism and Treatment of Ministry of Education, Harbin Medical University, Harbin 150086, P. R. China;

Corresponding author：

TIANHai, Email: doctor_tianhai@163.com

Keywords：

Hypertrophic obstructive cardiomyopathy; Mitral regurgitation; Surgery; Echocardiography

DOI：

10.7507/1007-4848.20160184

Video：

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Objective To summarize the surgical strategy on treating mitral desease patient associated with hypertrophic obstructive cadiomyopathy (HOCM). Methods We retrospectively analyzed the clinical data of 17 patients with HOCM underwent surgical treatment from November 2003 to May 2015 year. There were 10 males and 7 females with a mean age of 42.2±15.5 years ranging from 7-62 years. There were 16 patients underwent modified Morrow procedure and 1 patient underwent modified Konno procedure to relieve the obstruction of left ventricular outflow tract. And different surgical treatment of mitral valve disease was implemented depending on the severity of regurgitation and under monitoring of transesophageal echocardiography. About 2 weeks after the surgery, we performed transthoracic echocardiography to evaluate the effect of operation. Results No hospital death occurred and the surgery obviously improved the symptom and cardiac function in all cases. After surgery, echocardiography revealed that the mean thickness of the ventricular septum statistically decreased (P < 0.0001), the systolic anterior motion disappeared, the outflow track pressure of left ventricle statistically decreased (P < 0.0001), and the peak flow rate of left ventricle statistically decreased. However, there was no statistical difference in the change of the left ventricular ejection fraction(P=0.083). Nine patients with no mitral regurgitation (MR) or mild MR only underwent the unblock of the left ventricular outflow track, the MR decreased to mild or disappeared. Four patients with moderate or severe MR underwent mitral valve repair, and the MR decrease to mild or disappear. There were no complications occurred regarding to prosthesis implantation over the 4 patients underwent mitral valve replacement for infective endocarditis or other causes. Conclusion For the HOCM patients with mild MR, the unblock of the left ventricular outflow track alone can effectively improve the MR. For those combined with moderate or severe MR, we should choose mitral valve repair or replacement based on individual situation of patient.

Citation： KANGkai, CAIJun, JIAZhi-bo, ZHANGYu-nan, ZHANGChun-feng, ZHUZhi-tao, XIEBao-dong, JIANGShu-lin, TIANHai. Surgical Treatment of Mitral Desease Patients Associated with Hypertrophic Obstructive Cardiomyopathy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(8): 765-768. doi: 10.7507/1007-4848.20160184 Copy

1.	Morrow AG, Fogarty TJ, Hannah H, et al. Operative treatment in idiopathic hypertrophic subaortic stenosis. Techniques and the results of preoperative and postoperative clinical and hemodynamic assessments. Circulation, 1968, 37(4):589-596.
2.	Agarwal S, Tuzcu EM, Desai MY, et al. Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. See comment in PubMed Commons below. J Am Coll Cardiol, 2010, 55(8):823-834.
3.	Dearani JA, Ommen SR, Gersh BJ, et al. Surgery insight:Septal myec-tomy for obstructive hypertrophic cardiomyopathy——the Mayo Clinic experience. Nat Clin Pract Cardiovasc Med, 2007, 4(9):503-512.
4.	Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(24):2761-2796.
5.	Ommen SR, Maron BJ, Olivotto I, et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertro-phic cardiomyopathy. J Am Coll Cardiol, 2005, 46(3):470-476.
6.	Dearani JA, Schaff HV, Ommen SR. Septal myectomy for obstruc-tive hypertrophic cardiomyopathy:the gold standard. Zhonghua Xin Xue Guan Bing Za Zhi, 2009, 37(4):307-311.
7.	Roberts CS, Mcintosh CL, Brown PS, et al. Reoperation for persis-tent outflow obstruction in hypertrophic cardiomyopathy. Ann Thorac Surg, 1991, 51 (3):455-460.
8.	Cho YH, Quintana E, Schaff HV, et al. Residual and recurrent gradients after septal myectomy for hypertrophic cardiomyopathy mechanisms of obstruction and outcomes of reoperation. J Thorac Cardiovasc Surg, 2014, 148(3):909-916.
9.	Lefebre XP, Yoganathan AP, Levine RA, et al. Insights from in vitro flow visualization into the mechanism of systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy under steady flow conditions. J Biomed Eng, 1992, 114(3):406-413.
10.	Jiang L, Levine RA, King ME, et al. An integrated mechanism for systolic anterior motion of the mitral valve in hypertrophic cardio-myopathy based on echocardio-graphic observations. Am Heart J, 1987, 113 (3):633-644.
11.	Sherrid MV, Gunsburg DZ, Pearle G. Mid-systolic drop in left ventricular ejectionvelocity inobstructive hypertrophic cardiomyo-pathy-the lobster claw abnormality. J Am Soc Echocardiogr, 1997, 10(7):707-712.
12.	Hagège AA, Desnos M. New trends in treatment of hypertrophic cardiomyopathy. Arch Cardiovasc Dis, 2009, 102 (5):441-447.
13.	Teo EP, Teoh JG, Hung J, et al. Mitral valve and papillary muscle abnormalities in hypertrophic obstructive cardiomyopathy. Curr Opin Cardio, 2015, 30(5):475-482.
14.	Cooley DA, Wukasch DC, Leachman RD. Mitral valve replacement for idiopathic hypertrophic subaortic stenosis:Results in 27 patients. J Cardiovasc Surg (Torino), 1976, 17(5):380-387.
15.	任崇雷, 高长青, 王瑶, 等.超声心动图在肥厚性梗阻性心肌病外科治疗中的作用.中国体外循环杂志, 2015, 13(1):25-28.
16.	王颖骅, 薛松.肥厚性梗阻性心肌病的外科治疗.国际心血管病杂志, 2014, 41(5):324-326.
17.	Balaram SK, Ross RE, Sherrid MV, et al. Role of mitral valve plica-tion in the surgical management of hypertropic cardiomyopathy Ann Thorac Surg, 2012, 94(6):1990-1997.
18.	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.
19.	Hagège AA, Bruneval P, Levine RA, et al. The mitral valve in hyper-trophic cardiomyopathy:old versus new concepts. J Cardiovasc Transl Res, 2011, 4(6):757-766.
20.	Swistel DG, Balaram SK. Surgical myectomy for hypertrophic cardio-myopathy in the 21st century, the evolution of the "RPR" repair:resection, plication, and release. Prog Cardiovasc Dis, 2012, 54(6):498-502.
21.	Wan CK, Dearani JA, Sundt TM, et al. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degen-erative mitral regurgitation? Ann Thorac Surg, 2009, 88(3):727-731.

1. Morrow AG, Fogarty TJ, Hannah H, et al. Operative treatment in idiopathic hypertrophic subaortic stenosis. Techniques and the results of preoperative and postoperative clinical and hemodynamic assessments. Circulation, 1968, 37(4):589-596.
2. Agarwal S, Tuzcu EM, Desai MY, et al. Updated meta-analysis of septal alcohol ablation versus myectomy for hypertrophic cardiomyopathy. See comment in PubMed Commons below. J Am Coll Cardiol, 2010, 55(8):823-834.
3. Dearani JA, Ommen SR, Gersh BJ, et al. Surgery insight:Septal myec-tomy for obstructive hypertrophic cardiomyopathy——the Mayo Clinic experience. Nat Clin Pract Cardiovasc Med, 2007, 4(9):503-512.
4. Gersh BJ, Maron BJ, Bonow RO, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(24):2761-2796.
5. Ommen SR, Maron BJ, Olivotto I, et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertro-phic cardiomyopathy. J Am Coll Cardiol, 2005, 46(3):470-476.
6. Dearani JA, Schaff HV, Ommen SR. Septal myectomy for obstruc-tive hypertrophic cardiomyopathy:the gold standard. Zhonghua Xin Xue Guan Bing Za Zhi, 2009, 37(4):307-311.
7. Roberts CS, Mcintosh CL, Brown PS, et al. Reoperation for persis-tent outflow obstruction in hypertrophic cardiomyopathy. Ann Thorac Surg, 1991, 51 (3):455-460.
8. Cho YH, Quintana E, Schaff HV, et al. Residual and recurrent gradients after septal myectomy for hypertrophic cardiomyopathy mechanisms of obstruction and outcomes of reoperation. J Thorac Cardiovasc Surg, 2014, 148(3):909-916.
9. Lefebre XP, Yoganathan AP, Levine RA, et al. Insights from in vitro flow visualization into the mechanism of systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy under steady flow conditions. J Biomed Eng, 1992, 114(3):406-413.
10. Jiang L, Levine RA, King ME, et al. An integrated mechanism for systolic anterior motion of the mitral valve in hypertrophic cardio-myopathy based on echocardio-graphic observations. Am Heart J, 1987, 113 (3):633-644.
11. Sherrid MV, Gunsburg DZ, Pearle G. Mid-systolic drop in left ventricular ejectionvelocity inobstructive hypertrophic cardiomyo-pathy-the lobster claw abnormality. J Am Soc Echocardiogr, 1997, 10(7):707-712.
12. Hagège AA, Desnos M. New trends in treatment of hypertrophic cardiomyopathy. Arch Cardiovasc Dis, 2009, 102 (5):441-447.
13. Teo EP, Teoh JG, Hung J, et al. Mitral valve and papillary muscle abnormalities in hypertrophic obstructive cardiomyopathy. Curr Opin Cardio, 2015, 30(5):475-482.
14. Cooley DA, Wukasch DC, Leachman RD. Mitral valve replacement for idiopathic hypertrophic subaortic stenosis:Results in 27 patients. J Cardiovasc Surg (Torino), 1976, 17(5):380-387.
15. 任崇雷, 高长青, 王瑶, 等.超声心动图在肥厚性梗阻性心肌病外科治疗中的作用.中国体外循环杂志, 2015, 13(1):25-28.
16. 王颖骅, 薛松.肥厚性梗阻性心肌病的外科治疗.国际心血管病杂志, 2014, 41(5):324-326.
17. Balaram SK, Ross RE, Sherrid MV, et al. Role of mitral valve plica-tion in the surgical management of hypertropic cardiomyopathy Ann Thorac Surg, 2012, 94(6):1990-1997.
18. 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.
19. Hagège AA, Bruneval P, Levine RA, et al. The mitral valve in hyper-trophic cardiomyopathy:old versus new concepts. J Cardiovasc Transl Res, 2011, 4(6):757-766.
20. Swistel DG, Balaram SK. Surgical myectomy for hypertrophic cardio-myopathy in the 21st century, the evolution of the "RPR" repair:resection, plication, and release. Prog Cardiovasc Dis, 2012, 54(6):498-502.
21. Wan CK, Dearani JA, Sundt TM, et al. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degen-erative mitral regurgitation? Ann Thorac Surg, 2009, 88(3):727-731.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment of Mitral Desease Patients Associated with Hypertrophic Obstructive Cardiomyopathy

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