Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy Complicated by Infective Endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Mingyao , WANG Shuiyun

State Key Laboratory of Cardiovascular Disease， Fu Wai Hospital， Cardiovascular Institute， Chinese Academy of Medical Sciences﹠Peking Union Medical College， Beijing 100037， P. R. China;

Corresponding author：

Keywords：

Hypertrophic obstructive cardiomyopathy; ?Infective endocarditis; ?Modified Morrow procedure; 　Mitral valve replacement; ?Aortic valve replacement

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Abstract：?Objective?To analyze surgical procedures and clinical outcomes for patients with hypertrophic obstructive　cardiomyopathy （HOCM） complicated by infective endocarditis.?Methods?We retrospectively analyzed clinical data of 7 patients with HOCM complicated by infective endocarditis who underwent modified Morrow procedure，removal of　intracardiac vegetation，and valve replacement in Fu Wai Hospital from Sep. 2006 to Feb. 2012. There were 5 male patients　and 2 female patients with their mean age of 39.80±13.60 years（ranging 21-55）. Postoperative clinical outcomes were　observed. Preoperative and postoperative left ventricular outflow tract （LVOT） gradients， left atrium （LA） diameter，left　ventricular ejection fraction （LVEF） and heart function were compared.?Results?There was no in-hospital death and　perioperative survival rate was 100% in this group. Bacteria vegetations were multiply detected on the mitral valve leaflet　（7 cases）， aortic valve leaflet （4 cases） and ventricular septum （1 case） with their diameter of 2-19 mm. Blood culture showed Staphylococcus aureus （3 cases），Squirrel aureus （1 case） . Postoperatively， first-degree atrioventricular block　occurred in 2 patients， complete left bundle branch block in 1 patient， left anterior division block in 2 patients， and all these complications were not treated. Postoperative LVOT gradient and LA diameter were significantly lower than preoperative　values （P＜0.05）， and cardiac function was significantly improved in these patients. All the patients underwent transthoracic　echocardiography at a mean follow-up of 13.00±17.19 （1-49） months in outpatient service. The clinical symptoms of all these patients were diminished or significantly ameliorated and their quality of life was considerably improved. All the patients had NYHA classⅠorⅡ without any reintervention or death during follow-up.?Conclusion?Modified Morrow procedure and valve replacement is a good surgical strategy for patients with HOCM complicated by infective endocarditis with satisfactory early and mid-term clinical outcomes.

Citation： LUO Mingyao,WANG Shuiyun,YIN Zhaohua,SUN Hongtao,SONG Yunhu,YU Cuntao,QIAN Xiangyang,ZHENG Zhe,WANG Wei,HU Shengshou.. Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy Complicated by Infective Endocarditis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(6): 597-601. doi: Copy

1.	Louahabi T， Drighil A， Habbal R， et al. Infective endocarditis　complicating hypertrophic obstructive cardiomyopathy. Eur J Echocardiogr， 2006， 7 （6）：468-470.
2.	Alessandri N， Pannarale G， del Monte F， et al. Hypertrophic　obstructive cardiomyopathy and infective endocarditis：a report of seven cases and a review of the literature. Eur Heart J， 1990， 11 （11）：1041-1048.
3.	William CR， Kishel JC， Mcintosh CL， et al. Severe mitral or aortic valve regurgitation， or both， requiring valve replacement for infective endocarditis complicating hypertrophic cardiomyopathy. J Am Coll Cardiol， 1992， 19 （2）：365-371.
4.	Pachirat O， Klungboonkrong V， Tantisirin C. Infective endocarditis in hypertrophic cardiomyopathy——mural and aortic valve vegetations：a case report. J Med Assoc Thai， 2006， 89 （4）：522-526.
5.	Maron BJ， Lever H. In defense of antimicrobial prophylaxis for　prevention of infective endocarditis in patients with hypertrophic　cardiomyopathy. J Am Coll Cardiol， 2009， 54 （24）：2339-2340.
6.	Morgan-Hughes G， Motwani J. Mitral valve endocarditis in hypertrophic cardiomyopathy：case report and literature review. Heart， 2002， 87 （6）：e8.
7.	Chopra T， Bhargava A， Kumar S， et al. Candida kefyr endocarditis in a patient with hypertrophic obstructive cardiomyopathy. Am J Med Sci， 2010， 339 （2）：188-189.
8.	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.
9.	Garcia MF， Otto ME， Vieira NW， et al. Intraoperative evaluation and surgical planning in the hypertrophic cardiomyopathy. Arq Bras Cardiol， 2011， 96 （3）：e46-e49.
10.	Ashikhmina EA， Schaff HV， Ommen SR， et al. Intraoperative　direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy. J Thorac　Cardiovasc Surg， 2011， 142 （1）：53-59.
11.	Sgalambro A， Olivotto I， Rossi A， et al. Prevalence and clinical significance of acquired left coronary artery fistulas after surgical myectomy in patients with hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg， 2010， 140 （5）：1046-1052.
12.	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.
13.	Theis JL， Bos JM， Theis JD， et al. Expression patterns of cardiac myofilament proteins：genomic and protein analysis of surgical　myectomy tissue from patients with obstructive hypertrophic cardiomyopathy. Circ Heart Fail， 2009， 2 （4）：325-333.
14.	Zemanek D， Veselka J， Chmelova R. Infective endocarditis after alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Int Heart J， 2008， 49 （3）：371-375.
15.	Cunha BA， Esrick MD， Larusso M. Staphylococcus hominis native mitral valve bacterial endocarditis （SBE） in a patient with hypertrophic　obstructive cardiomyopathy. Heart Lung， 2007， 36 （5）：380-382.
16.	Spirito P， Rapezzi C， Bellone P， et al. Infective endocarditis in　hypertrophic cardiomyopathy：prevalence， incidence， and indications for antibiotic prophylaxis. Circulation， 1999， 99 （16）：2132-2137.
17.	Fyfe B， Ianosi-Irimie M， Motavalli L. Infective endocarditis complicating hypertrophic obstructive cardiomyopathy：an unusual mural pattern. Cardiovasc Pathol， 2010， 19 （1）：e5-e7.
18.	Wang SY， Cui B， Sun HS， et al. Clinical experience of surgical treatment on hypertrophic obstructive cardiomyopathy. Zhonghua Yi Xue Za Zhi， 2009， 89 （39）：2776-2778.
19.	Morrow AG， Fogarty TJ， Hannah H 3rd， 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.
20.	崔彬，许建屏，王巍，等. 心肌间隔切除术矫治肥厚梗阻型心肌病及围术期治疗策略. 中国胸心血管外科临床杂志， 2010， 17 （1）：6-9．.
21.	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 Cardiothorac Surg， 2012， [Epub ahead of print].
22.	孙宏涛，王水云，罗明尧，等. 隐匿性肥厚梗阻性心肌病的外科治疗. 中国分子心脏病学杂志， 2012， 12 （2）：65-67．.
23.	尹朝华，王水云，赵振华，等. 肥厚型梗阻性心肌病合并二尖瓣自身病变致二尖瓣关闭不全的外科治疗. 中国心血管病研究， 2010， 8 （6）：405-407．.

1. 　Louahabi T， Drighil A， Habbal R， et al. Infective endocarditis　complicating hypertrophic obstructive cardiomyopathy. Eur J Echocardiogr， 2006， 7 （6）：468-470.
2. 　Alessandri N， Pannarale G， del Monte F， et al. Hypertrophic　obstructive cardiomyopathy and infective endocarditis：a report of seven cases and a review of the literature. Eur Heart J， 1990， 11 （11）：1041-1048.
3. 　William CR， Kishel JC， Mcintosh CL， et al. Severe mitral or aortic valve regurgitation， or both， requiring valve replacement for infective endocarditis complicating hypertrophic cardiomyopathy. J Am Coll Cardiol， 1992， 19 （2）：365-371.
4. 　Pachirat O， Klungboonkrong V， Tantisirin C. Infective endocarditis in hypertrophic cardiomyopathy——mural and aortic valve vegetations：a case report. J Med Assoc Thai， 2006， 89 （4）：522-526.
5. 　Maron BJ， Lever H. In defense of antimicrobial prophylaxis for　prevention of infective endocarditis in patients with hypertrophic　cardiomyopathy. J Am Coll Cardiol， 2009， 54 （24）：2339-2340.
6. 　Morgan-Hughes G， Motwani J. Mitral valve endocarditis in hypertrophic cardiomyopathy：case report and literature review. Heart， 2002， 87 （6）：e8.
7. 　Chopra T， Bhargava A， Kumar S， et al. Candida kefyr endocarditis in a patient with hypertrophic obstructive cardiomyopathy. Am J Med Sci， 2010， 339 （2）：188-189.
8. 　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.
9. 　Garcia MF， Otto ME， Vieira NW， et al. Intraoperative evaluation and surgical planning in the hypertrophic cardiomyopathy. Arq Bras Cardiol， 2011， 96 （3）：e46-e49.
10. 　Ashikhmina EA， Schaff HV， Ommen SR， et al. Intraoperative　direct measurement of left ventricular outflow tract gradients to guide surgical myectomy for hypertrophic cardiomyopathy. J Thorac　Cardiovasc Surg， 2011， 142 （1）：53-59.
11. 　Sgalambro A， Olivotto I， Rossi A， et al. Prevalence and clinical significance of acquired left coronary artery fistulas after surgical myectomy in patients with hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg， 2010， 140 （5）：1046-1052.
12. 　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.
13. 　Theis JL， Bos JM， Theis JD， et al. Expression patterns of cardiac myofilament proteins：genomic and protein analysis of surgical　myectomy tissue from patients with obstructive hypertrophic cardiomyopathy. Circ Heart Fail， 2009， 2 （4）：325-333.
14. 　Zemanek D， Veselka J， Chmelova R. Infective endocarditis after alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Int Heart J， 2008， 49 （3）：371-375.
15. 　Cunha BA， Esrick MD， Larusso M. Staphylococcus hominis native mitral valve bacterial endocarditis （SBE） in a patient with hypertrophic　obstructive cardiomyopathy. Heart Lung， 2007， 36 （5）：380-382.
16. 　Spirito P， Rapezzi C， Bellone P， et al. Infective endocarditis in　hypertrophic cardiomyopathy：prevalence， incidence， and indications for antibiotic prophylaxis. Circulation， 1999， 99 （16）：2132-2137.
17. 　Fyfe B， Ianosi-Irimie M， Motavalli L. Infective endocarditis complicating hypertrophic obstructive cardiomyopathy：an unusual mural pattern. Cardiovasc Pathol， 2010， 19 （1）：e5-e7.
18. 　Wang SY， Cui B， Sun HS， et al. Clinical experience of surgical treatment on hypertrophic obstructive cardiomyopathy. Zhonghua Yi Xue Za Zhi， 2009， 89 （39）：2776-2778.
19. 　Morrow AG， Fogarty TJ， Hannah H 3rd， 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.
20. 　崔彬，许建屏，王巍，等. 心肌间隔切除术矫治肥厚梗阻型心肌病及围术期治疗策略. 中国胸心血管外科临床杂志， 2010， 17 （1）：6-9．.
21. 　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 Cardiothorac Surg， 2012， [Epub ahead of print].
22. 　孙宏涛，王水云，罗明尧，等. 隐匿性肥厚梗阻性心肌病的外科治疗. 中国分子心脏病学杂志， 2012， 12 （2）：65-67．.
23. 　尹朝华，王水云，赵振华，等. 肥厚型梗阻性心肌病合并二尖瓣自身病变致二尖瓣关闭不全的外科治疗. 中国心血管病研究， 2010， 8 （6）：405-407．.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Hypertrophic Obstructive Cardiomyopathy Complicated by Infective Endocarditis

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