Key result
Surgical myectomy for LVOTO in HCM provides good long-term outcomes and significant symptom relief.
Why the study?
Surgical management is an important treatment option for patients with hypertrophic cardiomyopathy and LVOTO who have persistent symptoms despite medication, but contemporary surgical practices and patient selection require clarification.
This review outlines the contemporary surgical management of left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, highlighting patient selection, anticipated results, and the role of echocardiography.
Surgery may relieve refractory symptoms in select HCM patients with LVOTO; leaves open optimal selection and comparison with newer therapies.
Hypertrophic cardiomyopathy is the single most common form of inherited heart disease. Left ventricular outflow tract obstruction (LVOTO) is a recognised feature of this condition which arises when blood leaving the outflow tract is impeded by systolic anterior motion of the mitral valve. In an important minority of patients, breathlessness, chest pain and syncope may result and persist despite the use of medications. In suitable candidates, surgery may relieve obstruction and its associated symptoms, and normalise life expectancy. Refinements in surgical techniques have marked improvements in the understanding of mechanisms underlying LVOTO. In this review, we hope to provide the reader with an understanding of how contemporary surgical practice has developed, which patients should be considered for surgery, and what results are anticipated. The role echocardiography plays in this area is highlighted throughout.
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Howell et al. (2015) conducted a review in Hypertrophic cardiomyopathy with left ventricular outflow tract obstruction. Surgical myectomy vs. Alcohol septal ablation or medical therapy (as discussed in literature) was evaluated. Surgical myectomy for left ventricular outflow tract obstruction in hypertrophic cardiomyopathy provides good long-term outcomes with low perioperative complications and significant symptom relief.
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