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Septal myectomy

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https://www.readbyqxmd.com/read/29154429/contrast-enhanced-computed-tomography-with-myocardial-three-dimensional-printing-can-guide-treatment-in-symptomatic-hypertrophic-obstructive-cardiomyopathy
#1
Yasuhiro Hamatani, Makoto Amaki, Hideaki Kanzaki, Kizuku Yamashita, Yasuteru Nakashima, Atsushi Shibata, Atsushi Okada, Hiroyuki Takahama, Takuya Hasegawa, Yusuke Shimahara, Yasuo Sugano, Tomoyuki Fujita, Isao Shiraishi, Satoshi Yasuda, Junjiro Kobayashi, Toshihisa Anzai
Both surgical myectomy and percutaneous transluminal septal myocardial ablation are effective treatments for drug-refractory symptomatic hypertrophic obstructive cardiomyopathy (HOCM). However, in some cases, it is not easy to elucidate the abnormal structure of left ventricular outflow obstruction to adopt these treatments. Here, we presented a young female patient with drug-refractory symptomatic HOCM. In this case, contrast-enhanced computed tomography enabled us to assess the suitability of percutaneous transluminal septal myocardial ablation...
November 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/29153286/combined-transaortic-and-transapical-approach-to-septal-myectomy-in-patients-with-complex-hypertrophic-cardiomyopathy
#2
Dustin Hang, Hartzell V Schaff, Steve R Ommen, Joseph A Dearani, Rick A Nishimura
OBJECTIVES: Residual midventricular obstruction after transaortic myectomy may lead to recurrent symptoms and reoperation in patients with hypertrophic cardiomyopathy and long-segment septal hypertrophy. A combined transaortic and transapical approach to septal myectomy during initial operation allows for the complete relief of subaortic and midventricular gradients and may reduce the risk of poor late functional results. METHODS: We analyzed the early outcomes of 86 patients aged 18 years or more who underwent combined transaortic and transapical septal myectomy for left ventricular outflow tract obstruction due to systolic anterior motion and midventricular obstruction or cavitary obliteration due to apical hypertrophic cardiomyopathy...
October 27, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29148156/long-term-outcomes-for-different-surgical-strategies-to-treat-left-ventricular-outflow-tract-obstruction-in-hypertrophic-cardiomyopathy
#3
Richard Collis, Oliver Watkinson, Constantinos O'Mahony, Oliver P Guttmann, Antonis Pantazis, Maria Tome-Esteban, Victor Tsang, Venkatachalam Chandrasekaran, Christopher G A McGregor, Perry M Elliott
AIMS: Surgical intervention is used to treat dynamic left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy. This study assesses the effect of different surgical strategies on long-term mortality and morbidity. METHODS AND RESULTS: In total, 347 patients underwent surgical intervention for LVOTO (1988-2015). Group A (n = 272) underwent septal myectomy; Group B (n = 33), septal myectomy and mitral valve (MV) repair; Group C (n = 22), myectomy and MV replacement; and Group D (n = 20), MV replacement alone...
November 16, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29122139/role-of-exercise-testing-in-hypertrophic%C3%A2-cardiomyopathy
#4
REVIEW
Ethan J Rowin, Barry J Maron, Iacopo Olivotto, Martin S Maron
Over the last 25 years, patients with hypertrophic cardiomyopathy (HCM) have been studied with a variety of methods employing physiological exercise that have made major contributions to disease management and are performed without increased risk. Previously under-utilized in HCM, exercise (stress) echocardiography has become incorporated into the standard clinical assessment and diagnostic armamentarium of HCM using upright or supine symptom-limited treadmill or bicycle modalities. In patients without outflow gradients at rest, exercise echocardiography is the most appropriate method for provoking obstruction, with the capability of predicting future development of progressive heart failure symptoms, and differentiating patients with provocable obstruction from those without obstruction, with major implications for dictating treatment options, that is, surgical myectomy (alternatively, alcohol septal ablation) versus heart transplant...
November 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29106577/pacing-for-hypertrophic-obstructive-cardiomyopathy-an-update-and-future-directions
#5
Claude Daubert, Fredrik Gadler, Philippe Mabo, Cecilia Linde
In hypertrophic cardiomyopathy (HCM) patients with symptoms caused by left ventricular outflow tract obstruction (LVOTO), treatment options include negative inotropic drugs, myectomy, septal alcohol ablation and AV sequential pacing with or without an implantable cardioverter defibrillator (ICD). Pacing is rarely used in spite of its relative simplicity and promising results. In this review the current evidence of AV sequential pacing from observational, randomised studies and long and very long-term follow-up studies is given and put in the context of present guidelines recommendations...
June 30, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29021349/activation-of-autophagy-ameliorates-cardiomyopathy-in-mybpc3-targeted-knockin-mice
#6
Sonia R Singh, Antonia T L Zech, Birgit Geertz, Silke Reischmann-Düsener, Hanna Osinska, Maksymilian Prondzynski, Elisabeth Krämer, Qinghang Meng, Charles Redwood, Jolanda van der Velden, Jeffrey Robbins, Saskia Schlossarek, Lucie Carrier
BACKGROUND: Alterations in autophagy have been reported in hypertrophic cardiomyopathy (HCM) caused by Danon disease, Vici syndrome, or LEOPARD syndrome, but not in HCM caused by mutations in genes encoding sarcomeric proteins, which account for most of HCM cases. MYBPC3, encoding cMyBP-C (cardiac myosin-binding protein C), is the most frequently mutated HCM gene. METHODS AND RESULTS: We evaluated autophagy in patients with HCM carrying MYBPC3 mutations and in a Mybpc3-targeted knockin HCM mouse model, as well as the effect of autophagy modulators on the development of cardiomyopathy in knockin mice...
October 2017: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29020402/women-with-hypertrophic-cardiomyopathy-have-worse-survival
#7
Jeffrey B Geske, Kevin C Ong, Konstantinos C Siontis, Virginia B Hebl, Michael J Ackerman, David O Hodge, Virginia M Miller, Rick A Nishimura, Jae K Oh, Hartzell V Schaff, Bernard J Gersh, Steve R Ommen
Aims: Sex differences in hypertrophic cardiomyopathy (HCM) remain unclear. We sought to characterize sex differences in a large HCM referral centre population. Methods and results: Three thousand six hundred and seventy-three adult patients with HCM underwent evaluation between January 1975 and September 2012 with 1661 (45.2%) female. Kaplan-Meier survival curves were assessed via log-rank test. Cox proportional hazard regression analyses evaluated the relation of sex with survival...
September 8, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28977350/e-e-ratio-and-outcome-prediction-in-hypertrophic-cardiomyopathy-the-influence-of-outflow-tract-obstruction
#8
Dai-Yin Lu, Bereketeab Hailesealassie, Ioannis Ventoulis, Hong-Yun Liu, Hsin-Yueh Liang, Iraklis Pozios, Marco Canepa, Susan Phillip, M Roselle Abraham, Theodore Abraham
Aims: Diastolic dysfunction is thought to be an important pathophysiologic component of hypertrophic cardiomyopathy (HCM). However, there are conflicting data on the potential value of the mitral E/e' ratio. We examined whether left ventricular outflow tract (LVOT) obstruction influences the value of E/e' in predicting outcomes in HCM. Methods and results: Patients who met diagnostic criteria for HCM were enrolled. Diastolic function was assessed with complete two-dimensional and Doppler echocardiography...
July 11, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28947201/concomitant-ablation-for-atrial-fibrillation-during-septal-myectomy-in-patients-with-hypertrophic-obstructive-cardiomyopathy
#9
Alexander V Bogachev-Prokophiev, Alexander V Afanasyev, Sergei I Zheleznev, Alexei N Pivkin, Michael S Fomenko, Ravil M Sharifulin, Alexander M Karaskov
OBJECTIVE: The appearance of atrial fibrillation is associated with significant clinical deterioration in patients with obstructive hypertrophic cardiomyopathy; therefore, maintenance of sinus rhythm is desirable. Guidelines and most articles have reported the results of catheter ablation and pharmacologic atrial fibrillation treatment; nevertheless, data regarding concomitant procedures during septal myectomy are limited. The aim of this study was to assess the outcomes of concomitant atrial fibrillation treatment in patients with obstructive hypertrophic cardiomyopathy...
September 1, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28944183/transaortic-septal-myectomy-techniques-and-pitfalls
#10
REVIEW
Anthony Ralph-Edwards, Rachel D Vanderlaan, Pietro Bajona
Hypertrophic cardiomyopathy (HCM) is the most common congenital cardiac disease, affecting up to 1 in 200 individuals. When it causes left ventricular outflow tract (LVOT) obstruction, treatment is indicated to reduce symptoms and the risk of sudden cardiac death. Pharmacologic therapy is the first line treatment, however if it fails, surgical myectomy or percutaneous ablation of the hypertrophic myocardium are the standard therapies to eliminate subaortic obstruction. Both surgical myectomy and percutaneous ablation have been demonstrated as safe and effective treatments; however, myectomy is the gold standard with a significantly lower complication rate and more complete and longstanding reduction of LVOT obstruction...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944182/right-ventricle-myectomy
#11
Konstantin V Borisov
Right ventricular (RV) hypertrophy is common in patients with hypertrophic cardiomyopathy (HCM), and is associated with more severe disease. Conventional surgical strategies such as the traditional Morrow procedure pose a particularly high risk to patients with severe hypertrophy and RV obstruction, for whom the most appropriate therapeutic approach has not yet been established. We have proposed a new technique for surgical correction in patients with hypertrophic obstructive cardiomyopathy and severe hypertrophy, which involves approaching the area of obstruction by entering through the conal part of the RV...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944181/septal-myectomy-after-failed-septal-alcohol-ablation
#12
Eduard Quintana, Pietro Bajona, María José Arguis, Susanna Prat-González
Despite septal myectomy remaining the gold standard septal reduction therapy for hypertrophic obstructive cardiomyopathy (HOCM), there has been a disproportionate use of alcohol septal ablation (ASA) worldwide. Absolute resolution of left ventricular outflow tract (LVOT) obstruction with ASA is not achieved in a substantial proportion of patients. The mechanisms of failure from ASA are partially understood and described. Residual obstruction in hypertrophic cardiomyopathy is associated with worse clinical outcomes and mortality...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944180/surgical-management-of-atrial-fibrillation-at-the-time-of-septal-myectomy
#13
Eduard Quintana, James L Cox
Atrial fibrillation (AF) may appear during the natural clinical course of hypertrophic cardiomyopathy (HCM). It is regarded as a complication of HCM and is a marker of advanced disease. AF is more likely to occur in untreated, obstructive HCM. Unfortunately, this represents a turning point that puts patients at increased risk of further disability, stroke and death. The presence of obstruction is an indication to proceed with septal myectomy to improve or resolve symptoms by ameliorating diastolic dysfunction...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944179/hypertrophic-cardiomyopathy-in-children
#14
Arman Arghami, Joseph A Dearani, Sameh M Said, Patrick W O'Leary, Hartzell V Schaff
Hypertrophic cardiomyopathy (HCM) occurs in 1 of 500 adults and is considered to be one of the most common causes of death in young people under 35 years of age. Children with HCM are usually asymptomatic and the overall annual mortality beyond the first year of life is 1%. Septal myectomy is safe and effective in children with obstructive HCM and published data shows improved late survival compared to untreated HCM. Patient selection and surgical expertise remain critical components to ensuring successful outcomes of septal myectomy, particularly when considering prophylactic myectomy in a seemingly asymptomatic patient...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944178/alcohol-septal-ablation-in-which-patients-and-why
#15
Paolo Spirito, Jessica Rossi, Barry J Maron
At present, surgical septal myectomy is regarded as the "gold standard" treatment for most patients with obstructive hypertrophic cardiomyopathy (HCM) and drug-refractory symptoms. However, the best results are obtained by those surgeons who have extensive experience with this operation at a small number of referral centers. In the mid-1990s, percutaneous alcohol septal ablation was introduced as an alternative to myectomy to reduce LV outflow gradient and heart failure symptoms in patients with obstructive HCM...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944177/isolated-septal-myectomy-for-hypertrophic-obstructive-cardiomyopathy-an-update-on-the-toronto-general-hospital-experience
#16
Rachel D Vanderlaan, Anna Woo, Anthony Ralph-Edwards
BACKGROUND: Isolated septal myectomy is considered the gold standard for refractory left ventricular outflow tract (LVOT) obstruction at centers with dedicated hypertrophic obstructive cardiomyopathy (HOCM) surgeons. In this paper, we provide an update on the Toronto General Hospital (TGH) experience for isolated septal myectomy and comment on the safety and efficacy of myectomy in patients with thin basal septal thickness at our institution. METHODS: We retrospectively reviewed all patients undergoing surgical myectomy at our institution from January 2012 to August 2016...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944176/results-of-surgical-septal-myectomy-for-obstructive-hypertrophic-cardiomyopathy-the-tufts-experience
#17
Hassan Rastegar, Griffin Boll, Ethan J Rowin, Noreen Dolan, Catherine Carroll, James E Udelson, Wendy Wang, Philip Carpino, Barry J Maron, Martin S Maron, Frederick Y Chen
BACKGROUND: For over 50 years, surgical septal myectomy has been the preferred treatment for drug-refractory heart failure symptoms in patients with obstructive hypertrophic cardiomyopathy (HCM). Over this time in the United States, the majority of myectomy operations have been performed in a small number of select referral centers. METHODS: We have taken the opportunity to report results from the relatively new Tufts HCM Center and surgical program, incorporated 13 years ago, during which 507 myectomies (52±14 years of age; 56% male) were performed by one cardiothoracic surgeon, Dr...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944175/long-term-outcome-of-simultaneous-septal-myectomy-and-anterior-mitral-leaflet-retention-plasty-in-hypertrophic-obstructive-cardiomyopathy-the-berlin-experience
#18
Eva Maria Delmo Walter, Mariano Francisco Javier, Roland Hetzer
BACKGROUND: Various surgical strategies designed to relieve left ventricular outflow tract obstruction (LVOTO) and correct mitral regurgitation (MR) in hypertrophic obstructive cardiomyopathy (HOCM) have evolved, yet reports on the long-term outcomes of each technique are scarce. We provide an update on over 20 years' experience at our institution in the standardized surgical treatment of HOCM. METHODS: Between April 1986 and April 2014, 320 cases of endomyocardial resection and 305 septal myectomies were performed at our institution...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944174/hypertrophic-obstructive-cardiomyopathy-the-leipzig-experience
#19
Jawad Khalil, Michael Kuehl, Pirose Davierwala, Friedrich Wilhelm Mohr, Martin Misfeld
BACKGROUND: Management of hypertrophic obstructive cardiomyopathy (HOCM) has evolved considerably over the last fifty years, and includes medical treatment as well as septal myectomy (SM) to relief symptoms caused by left ventricular outflow tract obstruction (LVOTO). We report the Leipzig Heart Center experience in the surgical management of patients with HOCM. METHODS: We collected data from all patient treated surgically with a myectomy for LVOTO in patients with HOCM between 1997 and 2016...
July 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28944173/hypertrophic-obstructive-cardiomyopathy-the-mayo-clinic-experience
#20
Kunal D Kotkar, Sameh M Said, Joseph A Dearani, Hartzell V Schaff
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease characterized by left ventricular hypertrophy in the absence of other etiologies. Clinical presentation may vary from asymptomatic to sudden cardiac death. Medical treatment is the first-line therapy for symptomatic patients. Extended left ventricular septal myectomy is the procedure of choice if medical treatment is unsuccessful or intolerable. MAYO CLINIC EXPERIENCE: More than 3,000 patients have had septal myectomy for HCM at the Mayo Clinic (MN, USA) from 1993 to 2016...
July 2017: Annals of Cardiothoracic Surgery
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