Why the study?
Does surgical relief of obstruction reverse acute systolic dysfunction and cardiogenic shock in patients with hypertrophic cardiomyopathy?
Does surgical relief of obstruction reverse acute systolic dysfunction and cardiogenic shock in patients with hypertrophic cardiomyopathy?
Surgical relief of obstruction can be a life-saving intervention for patients with hypertrophic cardiomyopathy presenting with acute systolic dysfunction and cardiogenic shock refractory to medical therapy.
May support surgical relief in refractory obstructive HCM shock; hypothesis-generating pending larger studies.
A 70-year-old male with known hypertrophic cardiomyopathy (HCM) and latent obstruction presented with new onset of cardiogenic shock. He had a new resting left ventricular (LV) outflow gradient of 90 mmHg, and new severe LV systolic dysfunction. Because of rapid deterioration despite medical management he was urgently sent for surgical relief of obstruction, which immediately reversed both the LV dysfunction and shock. A second patient, a 58-year-old male also with hypertrophic cardiomyopathy and latent obstruction presented with collapse, cardiogenic shock, 135 mmHg resting LV outflow gradient and new severe LV systolic dysfunction. His profound shock was irreversible with pharmacologic management, but surgical relief of obstruction reversed both his LV dysfunction and shock. Echocardiography plays a pivotal role in the management of these acutely ill patients.
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Sherrid et al. (2011) studied this question.
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