Key result
Excision of the hypertrophied interventricular septum from the right ventricle in 7 HOCM patients reduced mean LV gradients from 86.3 to 10.3 mmHg and RVOT gradients from 44.9 to 4.1 mmHg.
Why the study?
Does excision of the hypertrophied interventricular septum from the right ventricle improve symptoms and reduce gradients in patients with HOCM and simultaneous LV midcavity and RVOT obstruction?
Case Report (n=7)
Does excision of the hypertrophied interventricular septum from the right ventricle improve symptoms and reduce gradients in patients with HOCM and simultaneous LV midcavity and RVOT obstruction?
A novel right ventricular approach for septal myectomy in HOCM with biventricular obstruction effectively reduces gradients and improves symptoms while avoiding conduction system injury.
May support right ventricular myectomy in select biventricular HOCM; hypothesis-generating and requires prospective validation before practice change.
OBJECTIVE: The classic Morrow technique for hypertrophic obstructive cardiomyopathy (HOCM) in patients with simultaneous obstruction of left ventricular (LV) midcavity and right ventricular outflow tract (RVOT) combined with extreme left ventricular hypertrophy, is not effective. A new technique for HOCM surgical correction in patients with severe hypertrophy is proposed. METHODS: The excision of the asymmetrical hypertrophied area of the interventricular septum (IVS) causing simultaneous midventricular and RVOT obstruction was performed from the conal part of the right ventricle (RV) in the middle part of the right side of the IVS. Conceptually, this approach offers a number of advantages: it affords the excision of the asymmetrically hypertrophied area of the ventricular septum without penetration into the left ventricular cavity, it avoids mechanical damage to the heart conduction system and aortic valve and, for the surgeon, it improves the visual inspection of the area to be resected. Seven patients with the midventricular obstruction of the LV associated with RVOT obstruction [mean New York Heart Association (NYHA) class 3.0] underwent this procedure. The follow-up period was 24.8 ± 11.3 months. RESULTS: Six patients were free of symptoms (NYHA class I) and one was in NYHA class 2. There were no early or late deaths. The mean value of the echocardiographic intraventricular gradients in the LV decreased from 86.3 ± 9.9 to 10.3 ± 5.3 mmHg, the mean value of the gradients in the RVOT decreased to 44.9 ± 9.6 versus 4.1 ± 1.2 mmHg. Sinus rhythm without the block of the bundle of the right branch was noted in all patients after surgery. No patients needed the implantation of a cardioverter-defibrillator. CONCLUSION: This technique for the surgical correction of HOCM provides the effective simultaneous elimination of LV midventricular and RVOT obstruction. A major advantage is that injuries, in particular to the conduction system, are easily avoided.
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Konstantin Borisov (2012) conducted a case report in Hypertrophic obstructive cardiomyopathy (HOCM) (n=7). Excision of the asymmetrical hypertrophied area of the interventricular septum from the conal part of the right ventricle was evaluated on Echocardiographic intraventricular gradients in the left ventricle and right ventricular outflow tract. Excision of the hypertrophied interventricular septum from the right ventricle in 7 HOCM patients reduced mean LV gradients from 86.3 to 10.3 mmHg and RVOT gradients from 44.9 to 4.1 mmHg.
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