Original articleAdult cardiacTransapical Approach to Myectomy for Midventricular Obstruction in Hypertrophic Cardiomyopathy
Section snippets
Patients and Methods
After obtaining permission from the Mayo Clinic Institutional Review Board, we reviewed the records of 56 patients with HCM and midventricular obstruction who underwent myectomy between February 1997 and June 2012. During this interval 1,644 patients underwent myectomy for HCM-related obstruction. The study included data retrieval from the Mayo Clinic electronic health record, our cardiovascular surgical database, and follow-up questionnaires that include quality-of-life measures. The
Results
Among the 56 patients who underwent myectomy for midventricular obstruction, the mean age was 42 ± 17 years and 28 were men. Presenting symptoms were variable; 51% of patients had dyspnea, 25% had palpitations, 9% presented with syncope, and 5% presented with angina. Other presentations included thromboembolic stroke (2%), ventricular tachycardias (4%), and cardiac arrest (2%). Forty-two percent of patients (n = 23) had an implantable cardiac defibrillator preoperatively. Five patients had
Comment
Midventricular obstruction in HCM is less common than subaortic obstruction; it has a different pathophysiologic mechanism and, in untreated patients, may have a worse prognosis [4]. Unlike subaortic obstruction, which is caused by systolic anterior motion of the mitral valve leaflets, midventricular obstruction is attributable to systolic narrowing of the mid ventricle with apposition of the septum and papillary muscles. Thus, secondary mitral valve regurgitation is uncommon and is not a part
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