ABSTRACT
<b>[Background] </b>Surgical septal myectomy is the gold-standard therapy for hypertrophic obstructive cardiomyopathy (HOCM) in Europe and America. However, few cases underwent surgical septal myectomy in Japan. We have performed the surgical transaortic extended left ventricular myectomy (LV myectomy) as a first choice in HOCM patients unresponsive to pharmacologic therapy. We report the short and medium term clinical outcomes. <b>Methods</b> : From May 2012 to September 2014, 9 patients underwent extended LV myectomy without other accompanying procedures. All cases were symptomatic and peak left ventricular outflow tract pressure gradients (LVOTG) were 50 mmHg or more. We assessed clinical and echocardiographic outcomes at the short and medium term, intra-operative findings and cardiomyocyte pathological findings. <b>Results</b> : All patients (mean age 64.3 years, 56% female) underwent transaortic LV myectomy with no obvious complications. Postoperative LVOTG were controlled within 10 mmHg or less. SAM disappeared completely in all patients and MR decreased to mild or less. LVOTG sustained good control of 10 mmHg or less under low-dose dobutamine stress echocardiography at the medium term. <b>Conclusion</b> : Our transaortic extended LV myectomy procedure is effective in decreasing LVOTG, SAM and MR with low operative morbidity and mortality.
ABSTRACT
Objective To investigate the effectiveness and safety in pediatric patients (Age≤14 years) with hypertrophic obstructive cardiomyopathy (HOCM) treated by percutanous transluminal septal myocardial ablation (PTSMA). Methods Retrospectively analyzed the data from four pediatric(age≤14 years) patients with HOCM treated by PTSMA from March 2004 to June 2012, including their clinical data, coronary angiography and the results of PTSMA to evaluate the complication and clinical outcome after PTSMA. Results The left ventricular outlfow tract pressure gradient (LVOTPG) at rest decreased after operation when compared with pre-lablation level (32.0 mm Hg vs 80.0 mm Hg, P>0.05). The LVOTPG after premature beat decreased with signiifcant difference after ablation (40.0 mm Hg vs 122.5 mm Hg, P<0.05). During opration and hospitalization, 1 patient developed right bundle branch block, and another patient developed complete atrioventricular block, Both patients’ arrhythmia received after temporary pacing and medical treatment. No death and major clinical adverse event recorded after operation and during the 12 months follow up. Conclusions PTSMA was effective and safe for children with HOCM.