Surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GONG Jiamiao ,  RAN Jun , SONG Yunhu , LIU Yun , TANG Yajie , DENG Long , LIU Xiaoxi

Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

RAN Jun, Email: bbink@163.com

Keywords：

Hypertrophic obstructive cardiomyopathy; aortic stenosis; surgical treatment

DOI：

10.7507/1007-4848.201903044

Video：

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Objective To evaluate the clinical and follow-up results of the surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis. Methods We retrospectively analyzed the clinical data of the patients with hypertrophic obstructive cardiomyopathy plus aortic stenosis in our hospital from February 2008 to October 2015. There were 4 males and 3 females aged 55.6 ± 7.5 years. All the patients were received concomitant aortic valvulopasty at the time of modified extended Morrow procedure. Echocardiographic data and major complications were recorded through the outpatient clinic and telephone. Results The postoperative ventricular septal thickness, left ventricular outflow tract gradient and aortic gradient were significantly lower than those in preoperation with statistical differences (P<0.05). During the mean follow-up 25.6 ± 28.2 months period, 1 patient died of cerebral hemorrhage, 1 patient was implanted a permanent pacemaker, and 1 patient had a postoperative new-onset atrial fibrillation. All patients had a satisfied prosthetic valve function and the left ventricular outflow tract gradient. The patient's symptoms and heart function significantly improved postoperatively. Conclusion For patients with hypertrophic obstructive cardiomyopathy associated with moderate to severe aortic stenosis, concomitant aortic valvulopasty at the time of modified extended Morrow procedure is an appropriate and effective treatment, which can significantly alleviate the clinical symptoms, and improve quality of life with a satisfied prognosis.

Citation： GONG Jiamiao, RAN Jun, SONG Yunhu, LIU Yun, TANG Yajie, DENG Long, LIU Xiaoxi. Surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1233-1238. doi: 10.7507/1007-4848.201903044 Copy

1.	Zou Y, Song L, Wang Z, et al. Prevalence of idiopathic hypertrophic cardiomyopathy in China: a population-based echocardiographic analysis of 8080 adults. Am J Med, 2004, 116(1): 14-18.
2.	Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet, 2017, 389(10075): 1253-1267.
3.	Nishimura RA, Seggewiss H, Schaff HV. Hypertrophic obstructive cardiomyopathy surgical myectomy and septal ablation. Circ Res, 2017, 121(7): 771-783.
4.	Almeida I, Caetano F, Trigo J, et al. High left ventricular outflow tract gradient: aortic stenosis, obstructive hypertrophic cardiomyopathy or both? Rev Port Cardiol, 2015, 34(5): 357.e1-5.
5.	Piva E, Mattos B, Torres MA, et al. The diagnosis of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Arq Bras Cardiol, 2012, 99(1): 665-75.
6.	Laskey WK, Kussmaul WG, et al. Subvalvular gradients in patients with valvular aortic stenosis: Prevalence, magnitude, and physiological importance. Circulation, 2001, 104(9): 1019-1022.
7.	Panza JA, Maron BJ, et al. Valvular aortic stenosis and asymmetric septal hypertrophy: Diagnostic considerations and clinical and therapeutic implications. Eur Heart J, 1988, (Suppl E): 71-76.
8.	Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/ASE Committee to Update the 1997 guidelines for the clinical application of echocardiography). Circulation, 2003, 108(9): 1146-1162.
9.	Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
10.	Baumgartner H, Falk V, Bax J, et al. Group ESCSD 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
11.	Gersh BJ, Maron BJ, Bonow RO, et a1. 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.
12.	李浩杰, 宋云虎, 朱晓东, 等. 单中心室间隔心肌切除术治疗肥厚型梗阻性心肌病中远期结果分析. 中国循环杂志, 2016, 31(6): 573-577.
13.	Kayalar N, Schaff HV, Daly RC, et al. Concomitant septal myectomy at the time of aortic valve replacement for severe aortic stenosis. Ann Thorac Surg, 2010, 89(2): 459-464.
14.	Deb SJ, Schaff HV, Dearani JA, et al. Septal myectomy results in regression of left ventricular hypertrophy in patients with hypertrophic obstructive cardiomyopathy. Ann Thorac Surg, 2004, 78(6): 2118-2122.
15.	Wang J, Sun X, Xiao M, et al. Regional left ventricular reverse remodeling after myectomy in hypertrophic cardiomyopathy. Ann Thorac Surg, 2016, 102(1): 124-1231.
16.	Moravsky G, Bruchal-Garbicz B, Jamorski M, et al. Myocardial mechanical remodeling after septal myectomy for severe obstructive hypertrophic cardiomyopathy. J Am Soc Echocardiogr, 2013, 26(8): 893-900.
17.	Treibel TA, Kozor R, Schofield R, et al. Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol, 2018, 71(8): 860-871.
18.	Xu H, Duan Y, Yuan X, et al. Residual left ventricular hypertrophy with adverse clinical outcomes in patients with severe aortic stenosis and asymmetric septal hypertrophy after aortic valve replacement. Eur J Cardiothorac Surg, 2019.
19.	Parbhudayal RY, Güçlü A, Zweerink A, et al. Myocardial adaptation after surgical therapy differs for aortic valve stenosis and hypertrophic obstructive cardiomyopathy. Int J Cardiovasc Imaging, 2019, 35(6): 1089-1100.
20.	Hatani T, Kitai T, Murai R, et al. Associations of residual left ventricular and left atrial remodeling with clinical outcomes in patients after aortic valve replacement for severe aortic stenosis. J Cardiol, 2016, 68(3): 241-247.
21.	El-Hamamsy I, Lekadir K, Olivotto I, et al. Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy. Glob Cardiol Sci Pract, 2012, 2012(1): 9.
22.	Di Tommaso L, Stassano P, Mannacio V, et al. Asymmetric septal hypertrophy in patients with severe aortic stenosis: the usefulness of associated septal myectomy. J Thorac Cardiovasc Surg, 2013, 145(1): 171-175.

1. Zou Y, Song L, Wang Z, et al. Prevalence of idiopathic hypertrophic cardiomyopathy in China: a population-based echocardiographic analysis of 8080 adults. Am J Med, 2004, 116(1): 14-18.
2. Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet, 2017, 389(10075): 1253-1267.
3. Nishimura RA, Seggewiss H, Schaff HV. Hypertrophic obstructive cardiomyopathy surgical myectomy and septal ablation. Circ Res, 2017, 121(7): 771-783.
4. Almeida I, Caetano F, Trigo J, et al. High left ventricular outflow tract gradient: aortic stenosis, obstructive hypertrophic cardiomyopathy or both? Rev Port Cardiol, 2015, 34(5): 357.e1-5.
5. Piva E, Mattos B, Torres MA, et al. The diagnosis of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Arq Bras Cardiol, 2012, 99(1): 665-75.
6. Laskey WK, Kussmaul WG, et al. Subvalvular gradients in patients with valvular aortic stenosis: Prevalence, magnitude, and physiological importance. Circulation, 2001, 104(9): 1019-1022.
7. Panza JA, Maron BJ, et al. Valvular aortic stenosis and asymmetric septal hypertrophy: Diagnostic considerations and clinical and therapeutic implications. Eur Heart J, 1988, (Suppl E): 71-76.
8. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/ASE Committee to Update the 1997 guidelines for the clinical application of echocardiography). Circulation, 2003, 108(9): 1146-1162.
9. Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
10. Baumgartner H, Falk V, Bax J, et al. Group ESCSD 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 2017, 38(36): 2739-2791.
11. Gersh BJ, Maron BJ, Bonow RO, et a1. 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.
12. 李浩杰, 宋云虎, 朱晓东, 等. 单中心室间隔心肌切除术治疗肥厚型梗阻性心肌病中远期结果分析. 中国循环杂志, 2016, 31(6): 573-577.
13. Kayalar N, Schaff HV, Daly RC, et al. Concomitant septal myectomy at the time of aortic valve replacement for severe aortic stenosis. Ann Thorac Surg, 2010, 89(2): 459-464.
14. Deb SJ, Schaff HV, Dearani JA, et al. Septal myectomy results in regression of left ventricular hypertrophy in patients with hypertrophic obstructive cardiomyopathy. Ann Thorac Surg, 2004, 78(6): 2118-2122.
15. Wang J, Sun X, Xiao M, et al. Regional left ventricular reverse remodeling after myectomy in hypertrophic cardiomyopathy. Ann Thorac Surg, 2016, 102(1): 124-1231.
16. Moravsky G, Bruchal-Garbicz B, Jamorski M, et al. Myocardial mechanical remodeling after septal myectomy for severe obstructive hypertrophic cardiomyopathy. J Am Soc Echocardiogr, 2013, 26(8): 893-900.
17. Treibel TA, Kozor R, Schofield R, et al. Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol, 2018, 71(8): 860-871.
18. Xu H, Duan Y, Yuan X, et al. Residual left ventricular hypertrophy with adverse clinical outcomes in patients with severe aortic stenosis and asymmetric septal hypertrophy after aortic valve replacement. Eur J Cardiothorac Surg, 2019.
19. Parbhudayal RY, Güçlü A, Zweerink A, et al. Myocardial adaptation after surgical therapy differs for aortic valve stenosis and hypertrophic obstructive cardiomyopathy. Int J Cardiovasc Imaging, 2019, 35(6): 1089-1100.
20. Hatani T, Kitai T, Murai R, et al. Associations of residual left ventricular and left atrial remodeling with clinical outcomes in patients after aortic valve replacement for severe aortic stenosis. J Cardiol, 2016, 68(3): 241-247.
21. El-Hamamsy I, Lekadir K, Olivotto I, et al. Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy. Glob Cardiol Sci Pract, 2012, 2012(1): 9.
22. Di Tommaso L, Stassano P, Mannacio V, et al. Asymmetric septal hypertrophy in patients with severe aortic stenosis: the usefulness of associated septal myectomy. J Thorac Cardiovasc Surg, 2013, 145(1): 171-175.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment for hypertrophic obstructive cardiomyopathy associated with aortic stenosis

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