Surgical septal myectomy combined with papillary muscle resection and mitral valve replacement successfully eliminated LVOT obstruction and improved clinical symptoms in a patient with complex hypertrophic cardiomyopathy.
May support individualized surgery for LVOT obstruction in complex HCM; leaves open management of persistent mid-ventricular gradients.
A 27-year-old female presented with dyspnea, fatigue, and exertional angina is found to have hypertrophic cardiomyopathy with marked hypertrophy of the papillary muscles, apex, septum, and lateral wall of the left ventricle. Also, small left ventricular cavity and systolic anterior movement of anterior mitral leaflet were observed at the echocardiography. The Doppler echocardiography revealed severe peak gradients at the left ventricle outflow tract (105 mmHg) and mid-ventricle (80 mmHg). At the operation, septal myectomy and anterior papillary muscle resection in addition to mitral valve replacement was performed. Surgical treatment gave an excellent clinical result. Control Doppler echocardiograms revealed no left ventricular outflow tract gradient, although mid-ventricular gradient was persistent. The good results were still present 18 months after the operation.
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Güler et al. (2006) studied this question.
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