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Septal myectomy

Zachary Solomon, Catalina Breton, Ethan J Rowin, Barry J Maron, Martin S Maron, Frederick Y Chen, Hassan Rastegar
Left ventricular outflow tract obstruction secondary to hypertrophic obstructive cardiomyopathy remains a challenging entity facing clinicians. Despite the success of invasive therapies, some clinicians remain hesitant due to early results with unacceptable morbidity and mortality rates. However, current literature strongly suggests improved short and long-term outcomes with extended septal myectomy and alcohol septal ablation compared to patients not undergoing such interventions. This review evaluates hypertrophic obstructive cardiomyopathy treatment with a focus on short and long-term outcomes, perioperative complications, and major tenets of surgical intervention...
March 7, 2018: Seminars in Thoracic and Cardiovascular Surgery
Robert G Nampiaparampil, Daniel G Swistel, Michael Schlame, Muhamed Saric, Mark V Sherrid
Transesophageal echocardiography is essential in guiding the surgical approach for patients with obstructive hypertrophic cardiomyopathy. Septal hypertrophy, elongated mitral valve leaflets, and abnormalities of the subvalvular apparatus are prominent features, all of which may contribute to left ventricular outflow tract obstruction. Surgery aims to alleviate the obstruction via an extended myectomy, often with an intervention on the mitral valve and subvalvular apparatus. The goal of intraoperative echocardiography is to assess the anatomic pathology and pathophysiology in order to achieve a safe intraoperative course and a successful repair...
March 2018: Journal of the American Society of Echocardiography
Zahara Meghji, Anita Nguyen, Jeffrey B Geske, Hartzell V Schaff
Severe calcific mitral valve stenosis can rarely occur concomitantly with obstructive hypertrophic cardiomyopathy. In these patients, surgical decalcification of the stenotic mitral valve followed by mitral valve replacement carries significant operative risk and may result in paravalvular leakage, atrioventricular groove disruption, and excessive bleeding. We report the first 2 cases of obstructive hypertrophic cardiomyopathy with severe calcific mitral valve stenosis successfully treated with concomitant transaortic septal myectomy and bypass of the stenotic mitral valve using a valved left atrium to left ventricular conduit...
February 26, 2018: Annals of Thoracic Surgery
Hong-Chang Guo, Jin-Hua Li, Teng-Yong Jiang, Chang-Wei Ren, Jiang Dai, Yu-Jie Zhou, Yong-Qiang Lai
Background: Percutaneous transluminal septal myocardial ablation (PTSMA) and modified Morrow septal myectomy (MMSM) are two invasive strategies used to relieve obstruction in patients with hypertrophic cardiomyopathy (HCM). This study aimed to determine the clinical outcome of these two strategies. Methods: From January 2011 to January 2015, 226 patients with HCM were treated, 68 by PTSMA and 158 by MMSM. Both ultrasonic cardiograms and heart functional class were recorded before, after operations and in the follow-up...
March 5, 2018: Chinese Medical Journal
Amelie Burghardt, Frank van Buuren, Zisis Dimitriadis, Tim Grübbel, Hubert Seggewiss, Smita Scholtz, Dieter Horstkotte, Lothar Faber
BACKGROUND AND STUDY OBJECTIVE: Different studies have shown a good long-term survival with improvement of symptoms and hemodynamics after percutaneous septal ablation (PTSMA), similar to myectomy considered to be the therapeutic "gold standard" for symptomatic hypertrophic obstructive cardiomyopathy (HOCM). Furthermore, desobliteration of left ventricular (LV) outflow may modify features of the disease considered to be risk-relevant, such as magnitude of LV hypertrophy, outflow gradient, and left atrial (LA) size...
February 16, 2018: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Brody Wehman, Mehrdad Ghoreishi, Nathaniel Foster, Libin Wang, Michael N D'Ambra, Nathan Maassel, Sam Maghami, Rachael Quinn, Murtaza Dawood, Stacy Fisher, James S Gammie
BACKGROUND: Intrinsic abnormalities of the mitral valve are common in patients with hypertrophic cardiomyopathy and may need to be addressed at operation. METHODS: Consecutive patients undergoing transmitral septal myectomy were retrospectively reviewed. The ventricular septum was exposed through a left atriotomy, and the anterior leaflet of the mitral valve was detached from its annulus. An extended myectomy was performed to the base of the papillary muscles. After myectomy, the anterior leaflet was reattached and concomitant mitral valve repair or replacement was performed...
February 13, 2018: Annals of Thoracic Surgery
Yuting P Chiang, Yuichi J Shimada, Jonathan Ginns, Shepard D Weiner, Hiroo Takayama
Hypertrophic cardiomyopathy (HCM) is the most commonly inherited cardiac disease-recent studies suggest a prevalence as high as 1 in 200. For symptomatic patients with obstructive HCM who are refractory to medical therapy, septal reduction is indicated. Septal myectomy (SM) is considered the gold standard septal reduction technique. However, due to a shortage of surgeons who are experienced in this technique, alcohol septal ablation (ASA) has overtaken SM as the most commonly performed procedure for obstructive HCM...
February 15, 2018: General Thoracic and Cardiovascular Surgery
Carlos A Mestres, Thomas Bartel, Antonio Sorgente, Silvana Müller, Christiane Gruner, Joseph Dearani, Eduard Quintana
Hypertrophic cardiomyopathy is the most common genetic cardiovascular disorder and is associated with symptoms of heart failure and increased risk of sudden cardiac death. The most common condition is obstruction of the left ventricular outflow tract. Surgical septal myectomy and alcohol septal ablation are the 2 accepted modes of septal reduction therapy and are indicated when there are advanced symptoms and a peak left ventricular outflow gradient ≥50 mmHg. Advantages of alcohol septal ablation are limited groin approach, reduction of obstruction of the left ventricular outflow tract and functional improvement, but there are higher chances for intracardiac device implantation and residual obstruction...
February 9, 2018: European Journal of Cardio-thoracic Surgery
João Abecasis, Rosa Gouveia, Mariana Castro, Maria João Andrade, Regina Ribeiras, Sância Ramos, Miguel Abecasis, Nuno Cardim, Victor Gil
BACKGROUND: Subaortic septal myectomy is usually performed to mitigate obstruction in patients with the obstructive form of hypertrophic cardiomyopathy (HCM) or in those with congenital subaortic stenosis. Moreover, it is combined with aortic valve replacement in patients with severe aortic valve stenosis (SAS) and asymmetrical septal hypertrophy causing concomitant left ventricular outflow tract obstruction. When both conditions coexist, it is conceptually difficult to identify a cardiomyopathy beyond an adaptive myocardial hypertrophy, strictly related to pressure overload...
January 3, 2018: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Yongqiang Lai, Hongchang Guo, Jinhua Li, Jiang Dai, Changwei Ren, Yang Wang
The study was conducted to evaluate the surgical results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either classic Morrow septal myectomy or modified procedure.The modified Morrow septal myectomy has gained interest as a new treatment for patients with drug-refractory symptoms of HOCM; however, its benefits in comparison to the classic procedure are unknown.In all, 236 symptomatic HOCM patients underwent surgical treatment from January 2006 to January 2015. Among them, 86 patients were treated by the classic Morrow myectomy and 150 patients via the modified procedure...
December 2017: Medicine (Baltimore)
Sophie Wells, Ethan J Rowin, Griffin Boll, Hassan Rastegar, Wendy Wang, Martin S Maron, Barry J Maron
BACKGROUND: In the vast majority of patients with obstructive hypertrophic cardiomyopathy and drug-refractory heart failure, surgical myectomy results in reversal of heart failure symptoms. However, a small patient subgroup fails to experience sustained postoperative improvement despite relief of left ventricular outflow obstruction. Clinical profile of such patients has not been well defined. METHODS: Consecutive obstructive hypertrophic cardiomyopathy patients undergoing myectomy at Tufts Medical Center for drug refractory NYHA III/IV heart failure symptoms, 2004 to 2017, were followed postoperatively for 2...
January 15, 2018: American Journal of Medicine
Kanji Matsuzaki, Toru Tsukada, Masataka Sato, Yasunori Watanabe
We applied direct septal echography in transaortic septal myectomy for left ventricular outflow tract obstruction due to hypertrophic obstructive cardiomyopathy and asymmetric septal hypertrophy. A small L-shaped probe was inserted into the right ventricle through a 2-cm incision on the right ventricular outflow tract. The probe was placed directly on the interventricular septum to visualize its actual thickness. It was also helpful to push and expose the septum into a direct field of vision through the aortic annulus...
January 8, 2018: Interactive Cardiovascular and Thoracic Surgery
Uladzimir Andrushchuk, Vitali Adzintsou, Artem Nevyglas, Hanna Model
We present 2 cases of extended septal myectomy using low-cost 3-dimensional (3D) printed models of the interventricular septum with its fragment cut out mechanically or by initial 'virtual' myectomy. 3D prints exhibited excellent cardiac imaging and planning of the 'optimal' volume and shape of the resection, as well as intraoperative quality control of septal myectomy by filling a trough in the 3D-printed interventricular septum with excised myocardium.
December 20, 2017: Interactive Cardiovascular and Thoracic Surgery
Tadashi Kitamura, James Edwards, Kagami Miyaji
The interrupted noneverting mattress suture technique is typically used in conventional surgical aortic valve replacement. The continuous suture technique, although faster, has been associated with a higher incidence of paravalvular leak. Using a slightly modified technique to minimize this risk, we investigated whether continuous suturing would shorten aortic cross-clamp time in aortic valve replacement in comparison with interrupted suturing. We reviewed the cases and compared the perioperative data of 60 consecutive patients in Japan and Australia (35 men and 25 women; median age, 70 yr) who had undergone aortic valve replacement with or without septal myectomy...
December 2017: Texas Heart Institute Journal
Y P Ruan, X W Liu, Y Zhang, J C Han, Y Q Lai, J Lü, Y H He
Objective: To compare the early clinical effect of septal myectomy and percutaneous transluminal septal myocardial ablation (PTMSA) on the left ventricular outflow obstruction and the rate of complication in patients with hypertrophic obstructive cardiomyopathy (HOCM). Methods: A total of 204 patients with HOCM who received septal reduction treatment were recruited. These patients were divided into two groups, surgery group (n=135) (65 patients with modified Morrow procedure, 70 patients with non-Morrow myomectomy) and PTMSA group (n=69)...
December 5, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Tomoyuki Suzuki, Masaki Hata, Kazuhiro Yamaya, Takeshi Saitou, Fumiya Haba, Masahiro Matsuno
Emergent ascending aortic replacement and extended myectomy were performed in a woman with acute aortic dissection who was aged 63 years. Preoperative transthoracic echocardiography performed in the intensive care unit showed only slight left ventricular outflow tract (LVOT) obstruction, but intraoperative transesophageal echocardiography after induction of anesthesia revealed pericardial effusion, systolic anterior motion(SAM), and associated mitral regurgitation(MR). Perioperative SAM and MR are sometimes facilitated under various hemodynamic conditions, but in this case, the left ventricular wall was thick and LVOT appeared to be obstructive by a hypertrophied septum...
December 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Farah N Musharbash, Matthew R Schill, Matthew C Henn, Ralph J Damiano
Surgical septal myectomy is the treatment of choice for patients with symptomatic hypertrophic obstructive cardiomyopathy refractory to medications. This report describes our minimally invasive approach for performing a septal myectomy via a ministernotomy that has been used at our institution for more than a decade. In particular, patient preparation, surgical technique, and clinical considerations are highlighted. Performed properly, this minimally invasive technique is a feasible and effective approach in our experience...
November 2017: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Luis F Hidalgo, Srihari S Naidu, Wilbert S Aronow
Hypertrophic obstructive cardiomyopathy has been rising in prevalence, due to increased awareness and advanced imaging. For the symptomatic patient, pharmacological management remains an effective approach to the majority of patients with obstructive hypertrophic cardiomyopathy. However, a significant subset fails to improve sufficiently with medical therapy initially, or progressively becomes more symptomatic despite augmented medications over time. Most of the advances in the treatment of obstructive hypertrophic cardiomyopathy have therefore been made in the area of non-pharmacologic management, particularly septal reduction therapy...
January 2018: Expert Review of Cardiovascular Therapy
Julia Schleihauf, Julie Cleuziou, Jelena Pabst von Ohain, Christian Meierhofer, Heiko Stern, Nerejda Shehu, Naira Mkrtchyan, Emanuel Kaltenecker, Andreas Kühn, Nicole Nagdyman, Alfred Hager, Heide Seidel, Rüdiger Lange, Peter Ewert, Cordula M Wolf
No abstract text is available yet for this article.
March 1, 2018: European Journal of Cardio-thoracic Surgery
Yuting P Chiang, Jonathan N Ginns, Hiroo Takayama
No abstract text is available yet for this article.
November 7, 2017: Journal of Thoracic and Cardiovascular Surgery
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