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Minimally invasive trans-mitral septal myectomy for diffuse-type hypertrophic obstructive cardiomyopathy

Minimally invasive trans-mitral septal myectomy for diffuse-type hypertrophic obstructive... Objective Despite excellent long-term results reported for a trans-aortic septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM), surgery for patients with diffuse hypertrophy is very challenging. In addition, a left ventricular outflow obstruction is often aggravated by an abnormal mitral valve and subvalvular apparatus. Methods We performed video-assisted minimally invasive trans-mitral septal myectomy procedures in 3 patients with diffuse-type HOCM, who were highly symptomatic despite maximal medical therapy. Each had at least moderate mitral regurgitation (MR) due to systolic anterior motion (SAM). Using a right mini-thoracotomy, the anterior mitral leaflet was detached, through which an extended septal myectomy could easily be performed. Abnormal bridging chordae between the septum and papillary muscle (PM) were divided, then anterior mitral leaflet continuity was restored with direct closure or augmentation using a glutaraldehyde-treated autologous pericardium. A PM reorientation procedure was performed in 1 case in which both PMs were approximated and sutured onto the posterior ventricular wall. Results The postoperative course was uneventful in all patients, with marked improvement of symptoms in each. The peak ventricular outflow gradient decreased from 134 ± 40 to 23 ± 5 mmHg with significantly diminished SAM, especially in the patient who underwent the PM reorientation procedure. During a mean http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png General Thoracic and Cardiovascular Surgery Springer Journals

Minimally invasive trans-mitral septal myectomy for diffuse-type hypertrophic obstructive cardiomyopathy

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Publisher
Springer Journals
Copyright
Copyright © 2018 by The Japanese Association for Thoracic Surgery
Subject
Medicine & Public Health; Thoracic Surgery; Cardiac Surgery; Cardiology; Surgical Oncology
ISSN
1863-6705
eISSN
1863-6713
DOI
10.1007/s11748-018-0908-z
pmid
29549506
Publisher site
See Article on Publisher Site

Abstract

Objective Despite excellent long-term results reported for a trans-aortic septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM), surgery for patients with diffuse hypertrophy is very challenging. In addition, a left ventricular outflow obstruction is often aggravated by an abnormal mitral valve and subvalvular apparatus. Methods We performed video-assisted minimally invasive trans-mitral septal myectomy procedures in 3 patients with diffuse-type HOCM, who were highly symptomatic despite maximal medical therapy. Each had at least moderate mitral regurgitation (MR) due to systolic anterior motion (SAM). Using a right mini-thoracotomy, the anterior mitral leaflet was detached, through which an extended septal myectomy could easily be performed. Abnormal bridging chordae between the septum and papillary muscle (PM) were divided, then anterior mitral leaflet continuity was restored with direct closure or augmentation using a glutaraldehyde-treated autologous pericardium. A PM reorientation procedure was performed in 1 case in which both PMs were approximated and sutured onto the posterior ventricular wall. Results The postoperative course was uneventful in all patients, with marked improvement of symptoms in each. The peak ventricular outflow gradient decreased from 134 ± 40 to 23 ± 5 mmHg with significantly diminished SAM, especially in the patient who underwent the PM reorientation procedure. During a mean

Journal

General Thoracic and Cardiovascular Surgery – Springer Journals

Published: Mar 16, 2018

References

  • Surgery insight: septal myectomy for obstructive hypertrophic cardiomyopathy—the Mayo Clinic experience
    Dearani, JA; Ommen, SR; Gersh, BJ; Schaff, HV; Danielson, GK
  • The mitral valve in obstructive hypertrophic cardiomyopathy. A test in context
    Sherrid, MV; Balaram, S; Kim, B; Axel, L; Swistel, DG
  • Transatrial and transmitral approach for left ventricular myectomy and mitral valve plication for diffuse-type hypertrophic obstructive cardiomyopathy: a novel approach
    Matsuda, H; Nomura, F; Kadoba, K; Taniguchi, K; Imagawa, H; Kagisaki, K
  • Myectomy and mitral repair through the left atrium in hypertrophic obstructive cardiomyopathy: the preferred approach for contemporary surgical candidates?
    Gutermann, H; Pettinari, M; Kerrebroeck, C; Laenen, MV; Engelen, K; Fret, T
  • A simple method of prevention for systolic anterior motion in mitral valve repair by loop technique method
    Kudo, M; Yozu, R; Kokaji, K; Kimura, N
  • Idiopathic hypertrophic subaortic stenosis can be treated endoscopically
    Casselman, F; Vanermen, H
  • Diversity of structural mitral valve alterations in hypertrophic cardiomyopathy
    Klues, HG; Maron, BJ; Dollar, AL; Roberts, WC
  • Role of mitral valve plication in the surgical management of hypertrophic cardiomyopathy
    Balaram, SK; Ross, RE; Sherrid, MV; Schwartz, GS; Hillel, Z; Winson, G
  • Edge-to-edge technique to treat post-mitral valve repair systolic anterior motion and left ventricular outflow tract obstruction
    Mascagni, R; Attar, NA; Lamarra, M; Calvi, S; Tripodi, A; Mebazaa, A
  • Long-term benefit of myectomy and anterior mitral leaflet extension in obstructive hypertrophic cardiomyopathy
    Vriesendorp, PA; Schinkel, AFL; Soliman, OII; Kofflard, MJM; Jong, PL; Herwerden, LA
  • Anomalous insertion of papillary muscle directly into anterior mitral leaflet in hypertrophic cardiomyopathy. significance in producing left ventricular outflow obstruction
    Klues, HG; Roberts, WC; Maron, BJ
  • A new concept for correction of systolic anterior motion and mitral valve regurgitation in patients with hypertrophic obstructive cardiomyopathy
    Seeburger, J; Passage, J; Borger, MA; Mohr, FW
  • Transaortic chordal cutting. Mitral valve repair for obstructive hypertrophic cardiomyopathy with mild septal hypertrophy
    Ferrazzi, P; Spirito, P; Iacovoni, A; Calabrese, A; Migliorati, K; Simon, C
  • Papillary muscle realignment for symptomatic left ventricular outflow tract obstruction
    Bryant, R; Smedira, NG
  • Characteristics and surgical outcomes of symptomatic patients with hypertrophic cardiomyopathy with abnormal papillary muscle morphology undergoing papillary muscle reorientation
    Kwon, DH; Smedira, NG; Thamilarasan, M; Lytle, BW; Lever, H; Desai, MY
  • Mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy. Implications for concomitant valve procedures
    Hong, JH; Schaff, HV; Nishimura, RA; Abel, MD; Derarani, JA; Li, Z
  • Late results of mitral valve repair with glutaraldehyde-treated autologous pericardium
    Shomura, Y; Okada, Y; Nasu, M; Koyama, T; Yuzaki, M; Murashita, T
  • Mitral valve stenosis progression due to severe calcification on glutaraldehyde-treated autologous pericardium: word of caution for an attractive repair technique
    Fukunaga, N; Matsuo, T; Saji, Y; Imai, Y; Koyama, T