Adult: Hypertrophic CardiomyopathyIs anterior mitral valve leaflet length important in outcome of septal myectomy for obstructive hypertrophic cardiomyopathy?
Graphical abstract
Section snippets
Study Patients
Following approval by our Institutional Review Board, we examined the records of 564 consecutive patients with HCM undergoing septal myectomy for LVOT obstruction between February 2015 and April 2018. We gathered data from our surgical database, operative notes, and reports of preoperative and postoperative transthoracic echocardiograms (TTEs). For anatomic comparison, we accessed our cardiac surgery database for all isolated coronary artery bypass grafting (CABG) operations and aortic valve
Study Population
Baseline characteristics of HCM patients undergoing septal myectomy are shown in Table 1 along with data of patients undergoing AVR and CABG who served as controls for assessment of MV leaflet length. Median age at the time of septal myectomy was 60.3 (50.2-67.7) years, significantly younger than 66.4 (59.4-73.2) years and 71 (64.3, 76) years in the isolated CABG and isolated AVR cohorts, respectively (P < .001). The proportion of female patients was higher in the myectomy and isolated AVR
Discussion
The present study extends the understanding of MV pathology in patients with obstructive HCM, especially with regard to extended septal myectomy for relief of LVOT obstruction. Our findings support previous pathologic, echocardiographic, and cardiovascular magnetic resonance imaging studies that document increased leaflet length in patients with HCM compared with controls.2,10, 11, 12, 13, 14, 15 Increased leaflet length, however, did not impact surgical outcome as measured by LVOT gradient
Conclusions
MV leaflet elongation is a feature of obstructive HCM, but the median extent of elongation is small. We have found no clinically important association between the length of MV leaflets and the severity of LVOT obstruction or postoperative outcomes in patients undergoing surgical treatment. In our experience, in the absence of intrinsic MV disease, adjunctive leaflet procedures are rarely necessary and properly performed transaortic extended septal myectomy reliably relieves dynamic LVOT
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Cited by (11)
Commentary: Light on the long shadow of systolic anterior motion
2023, Journal of Thoracic and Cardiovascular SurgeryCommentary: Is length (of the anterior mitral leaflet) important?
2023, Journal of Thoracic and Cardiovascular SurgeryCommentary: Hypertrophic cardiomyopathy and the mitral valve—the debate continues
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2023, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :It should be noted that 46 of the 49 patients in this study had LVOT obstruction, and obstructive physiology is present in a minority of the general population of patients with HCM.17 Also, the risk of chordal rupture may be influenced by morphologic abnormalities of the mitral valve that have been described in HCM.18,19 In this study, the median interval between diagnosis of HCM and identification of ruptured chordae was 7 years, and myxomatous degeneration was identified on pathologic examination in two-thirds of the patients with excised valve tissue.
Challenge in mitral valve intervention: Super-elongated anterior and diminutive posterior mitral valve
2024, Journal of Clinical UltrasoundSeptal Myectomy and Subvalvular Repair in Hypertrophic Cardiomyopathy, a Systematic Review and Pooled Analysis
2023, Reviews in Cardiovascular Medicine
This work was supported by the Paul and Ruby Tsai Family.
Institutional Review Board 19-003279 (approved April 11, 2019).