ABSTRACT
Septal myectomy and mitral valve surgery are performed for the treatment of hypertrophic obstructive cardiomyopathy (HOCM) ; however, there is a debate as to which is the better option. In this paper, we report on the eventless postoperative course of a patient who underwent septal myectomy and mitral valve replacement simultaneously to treat HOCM accompanied by severe mitral regurgitation. A 75-year-old woman was referred to our department for severe mitral regurgitation accompanied by exertional dyspnea; we observed systolic anterior motion of the anterior mitral leaflet and a left ventricular outflow tract pressure gradient of 130 mmHg that was not decreased by DDD pacing. A 15×6×15-mm rectangular parallele pipe-shaped section of the hypertrophied basal septum was resected via a transaortic approach. In addition, mitral valve replacement with a 25-mm SJM was performed during the same procedure, as lesions were observed in the mitral valve. After surgery, the left ventricular outflow tract pressure gradient decreased by 12.5 mmHg. Necessary and sufficient resection of the hypertrophied basal septum, after careful preoperative and intraoperative evaluation of the extent of myocardial resection and mitral valve lesions is important for improving left ventricular outflow tract pressure gradient in HOCM. Mitral valve replacement should also be performed, if necessary, to treat mitral valve lesions.
ABSTRACT
To reduce the amount of homologous blood transfusion, recombinant human erythropoietin (rHuEPO) administration or preoperative autologous blood donation were performed in 42 patients who underwent elective heart surgery. rHuEPO was administrated intravenously every two days from the 14th preoperative day to the 14th postoperative day (Group E; 19 cases). Preoperative autologous blood donation was done from the 14th day prior to operation once or twice (Group S; 13 cases). There were another 10 cases who did not receive rHuEPO administration or make preoperative blood donations (Group C). In every case, autologous blood donation was performed during preparation for cardiopulmonary bypass at operation. No homologous blood transfusion was done in 14 cases of Group E (74%), 11 cases of Group S (85%), and 6 cases of Group C (60%). Of the 11 patients who required homologous blood transfusion, one was elderly (>65y. o.), 3 had prolonged cardiopulmonary bypass (>3hr), 3 had low body weight (<45kg), 1 had anemia at administration with a red blood cell count of <3.5×10<sup>6</sup>/mm<sup>3</sup>, and 2 cases had large blood loss during operation (>1, 200ml).